Objective: Pulsatility index (PI) is a parameter calculated by transcranial Doppler sonography (TCD), which is commonly used for patients with subarachnoid hemorrhage or ischemic stroke. However, we performed a retrospective analysis of patients with acute spontaneous intracerebral hemorrhage (ICH) to assess the function of TCD, particularly the PI. Methods: This study involved a total of 46 patients with acute ICH who received treatment at a single center between May 2013 and December 2014. Medical records of baseline characteristics, except for the modified Rankin scale, were obtained at initial evaluation in the emergency room, and TCD was used to calculate middle cerebral artery flow velocity (MFV) and PI at admission (baseline), 24 h, and 7 days. The PI and MFV values on the affected middle cerebral artery were compared with those on the contralateral side. Linear regression analysis was used for statistical analyses (SPSS 21.0, IBM Corp., Armonk, NY, USA). Results: Statistical analysis indicated that sex, age, Glasgow coma scale, intraventricular hemorrhage, and hematoma size were not correlated with PI (p＞0.05); however, only PI was positively correlated with functional outcome at 6 months after treatment (R=0.846, p=0.002). Conclusions These results provide evidence that the parameter of PI is an independent determinant prognostic factor in acute spontaneous ICH. Further research is needed to investigate the influence of cerebral blood flow dynamics on a larger, more controlled, and more randomized basis.

During the course of evaluation and management of neck masses, consideration for Immunoglobulin G4-related disease (IgG4-RD) should be given. IgG4-RD is relatively a new growing entity of immune-mediated origin, characterized by a mass-forming lesion, the infiltration of IgG4-positive plasma cells and occasionally elevated serum IgG4. The most common manifestations are parotid and lacrimal swelling, lymphadenopathy and autoimmune pancreatitis. A previously healthy 72-year-old man was referred to our clinic with a 2-month history of left cervical lymph node enlargement without systemic manifestations . A cervical lymph node biopsy was planned because of elevated serum IgG4 levels. Pathological findings showed prominent infiltration of IgG4-postive plasma cells in the lymph node. After steroid therapy, a computed tomography scan revealed a decrease in the cervical lymph node size. This case illustrates the importance of including IgG4-RD in the differential diagnosis of a cervical lymph node enlargement.
Aged ; Biopsy ; Diagnosis, Differential ; Humans ; Immunoglobulin G ; Immunoglobulins ; Lymph Nodes* ; Lymphatic Diseases* ; Neck ; Pancreatitis ; Plasma Cells

Gitelman syndrome is characterized by hypokalemia, metabolic alkalosis, hypocalciuria, and hypomagnesemia. The clinical course of Gitelman syndrome in pregnant women remains unclear, but it is thought to be benign. We report here the first Korean case of atypical eclampsia in a 31-year-old who was diagnosed with Gitelman syndrome incidentally during an antenatal screening test. The patient did well during pregnancy despite significant hypokalemia. At 33 weeks’ gestation, the patient exhibited eclampsia, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and renal insufficiency without significant hypertension or proteinuria. We explain this unusual clinical course through a review of the relevant literature.
Adult ; Alkalosis ; Eclampsia ; Female ; Gitelman Syndrome* ; HELLP Syndrome* ; Hemolysis ; Humans ; Hypertension ; Hypokalemia ; Liver ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis ; Proteinuria ; Renal Insufficiency

PURPOSE: Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III–IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH. METHODS: We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler. RESULTS: Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur. CONCLUSION: PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III–IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids.
Abscess ; Busan ; Constriction, Pathologic ; Female ; Hemorrhage ; Hemorrhoids* ; Humans ; Length of Stay ; Male ; Medical Records ; Mucous Membrane ; Rectovaginal Fistula ; Recurrence ; Retrospective Studies ; Sepsis ; Skin ; Surgeons ; Sutures ; Urinary Retention

PURPOSE: The most common risk factor for fecal incontinence (FI) is obstetric injury. FI affects 1.4%–18% of adults. Most patients are unaware when they are young, when symptoms appear suddenly and worsen with aging. Autologous fat graft is widely used in cosmetic surgical field and may substitute for injectable bulky agents in treating FI. Authors have done fat graft for past several years. This article reports the effectiveness of the fat graft in treating FI and discusses satisfaction with the procedure. METHODS: Fat was harvested from both lateral thighs using 10-mL Luer-loc syringe. Pure fat was extracted from harvests and mixed with fat, oil, and tumescent through refinement. Fats were injected into upper border of posterior ano-rectal ring, submucosa of anal canal and intersphincteric space. Thirty-five patients with FI were treated with this method from July 2016 to February 2017 in Busan Hangun Hospital. They were 13 male (mean age, 60.8 years) and 22 female patients (mean age, 63.3 years). The Wexner score was checked before procedure. We evaluated outcome in outpatients by asking the patients. For 19 patients we checked the Wexner score after procedure. RESULTS: Symptom improved in 29 (82.9%), and not improved in 6 (17.1%). In 2 of 6 patients, they felt better than before procedure, although not satisfied. No improvement in 4. Mean Wexner score was 9.7 before procedure. There were no serious complications such as inflammation or fat embolism. CONCLUSION: Autologous fat graft can be an effective alternative treatment for FI. It is safe and easy to perform, and cost effective.
Adult ; Aging ; Anal Canal ; Busan ; Embolism, Fat ; Fats ; Fecal Incontinence ; Female ; Humans ; Inflammation ; Male ; Methods ; Outpatients ; Risk Factors ; Syringes ; Thigh ; Transplants