No abstract available.

STUDY DESIGN: A case of brain infarction due to occlusion of vertebral artery after cervical spine fracture is reported. OBJECTIVES: Documentation of possibility and clinical significances of brain infarction as one of grave complications after cervical spine injury. SUMMARY OF LITERATURE REVIEW: Occlusion of vertebral artery and consequent brain infarction can be associated with cervical spine injuries because vertebral arteries course through the transverse foramina from sixth to second corvical vertebrae. Infarction of vertebrobasilar system may cause impairment of cerebral, cerebellar, or brain stem function and can occasionally bring grave functional loss, even death. MATERIALS AND METHODS: A case of occlusion of vertebral artery and consequent cerebral infarction after cervical spine fracture in a 66 year-old man. Brain CT and angiogram were performed. He was managed with anticoagulants. RESULTS: Neurologic deficits from brain infarction disappeared after 2 weeks. CONCLUSIONS: Attention to the possibility of these complications and awareness of their clinical features seem to be mandatory in managing cervical spine injury patients.
Aged ; Anticoagulants ; Brain ; Brain Infarction ; Brain Stem ; Cerebral Infarction* ; Humans ; Infarction ; Neurologic Manifestations ; Spine* ; Vertebral Artery*

Recently, water birth - labor and/or delivery under warm water - is acceptable and natural to many foreign countries as a method of gentle birth. Although some limitations after water birth were reported, a recent international conference explored many of the issuses and indicated the potential scale and the advantages for its inclusion among the options for labor and delivery under water. We experienced a case of water birth who underwent labor and delivery under water. She delivered normal healthy female baby without conventional episiotomy. No obstetrical ans fetal complications were observed during entire procedure of water birth. So, we report this case with brief review of the literatures.
Episiotomy ; Female ; Humans ; Parturition*

Ovarian pregnancy is an uncommon form of ectopic gestation that is often difficult to diagnose. The diagnostic criteria were described in 1878 by Spiegelberg, which comprise that the pregnancy is in the ovary and does not involve the tube. Primary ovarian pregnancy results in maternal hemorrhage early in the first trimester, and is usually accompanied by rupture of ovary with hemoperitoneum to require emergency operation. Misdiagnosis is common because it is confused with a ruptured corpus luteum. One case of ovarian pregnancy was presented with a brief review of literatures.
Corpus Luteum ; Diagnostic Errors ; Emergencies ; Female ; Gestational Age* ; Hemoperitoneum ; Hemorrhage ; Humans ; Ovary ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy, Ectopic* ; Rupture

Spinal cord stimulation (SCS) has become an established clinical option for treatment of refractory chronic pain. Current hardware and implantation techniques for SCS are already highly developed and continuously improving; however, equipment failures over the course of long-term treatment are still encountered in a relatively high proportion of the cases treated with it. Percutaneous SCS leads seem to be particularly prone to dislocation and insulation failures. We describe our experience of lead breakage in the inserted spinal cord stimulator to a complex regional pain syndrome patient who obtained satisfactory pain relief after the revision of SCS.
Chronic Pain ; Dislocations ; Equipment Failure ; Humans ; Spinal Cord ; Spinal Cord Stimulation

BACKGROUND: Selective serotonin reuptake inhibitor (SSRI) is believed to accelerate wound healing, and thus expected to have a positive effect on rotator cuff repair. We hypothesized that SSRI has a positive effect on the healing of the bonetendon interface (BTI), and improved rotator cuff tear healing would be confirmed by mechanical strength measurements and histological assessment of the restored tendon. METHODS: The study used 40 adult male Sprague–Dawley wild-type rats. The animals were divided into two groups:group-SSRI, the supraspinatus repair with SSRI injection group, and group-C, conventional supraspinatus repair only without SSRI. Biomechanical and histological analyses were performed 8 weeks after index rotator cuff surgery. RESULTS: The ultimate load (N) was significantly higher in group-SSRI than in group-C (54.8 ± 56.9 Vs 25.1 ± 11.1, p = .031). In the histological evaluation, the Bonar score confirmed significant differences in collagen fiber density (groupC: 0.6 ± 0.5, group-SSRI: 1.1 ± 0.6, p = .024), vascularity (group-C: 0.1 ± 0.2, group-SSRI: 0.3 ± 0.4, p = .024) and cellularity (group-C: 1.7 ± 0.4, group-SSRI: 2.0 ± 0.0, p = .023) between the groups. Based on the total score, groupSSRI was significantly better compared with group-C (6.3 ± 2.7 Vs 4.3 ± 1.9, p = .019). CONCLUSION Our study demonstrated that SSRI could facilitate improved biomechanical and histological outcomes 8 weeks after rotator cuff repair in a rat model. Consequently, SSRI may improve healing after rotator cuff repair.

BACKGROUND: Human immunodeficiency virus (HIV) infection results in a selective CD4+ T cell depletion and an impairment of T cell regulation. Despite the immune depletion, the progression of HIV infection is accompanied by the stimulation of antibody synthesis. Thus, the prevalence and amplitude of the increase of total serum IgE level and the relationship between the IgE levels and the degree of immunodeficiency were evaluated in patients with HIV infection. METHOD: Twenty-six Korean adults infected with HIV, in different stages, were evaluated for serum IgE level and CD4+ T cell count. Serum IgG, IgM and IgA levels were also determined. All subjects enrolled in this study denied an individual and familial history of atopic diseases. The possibility of parasitic infestation was also excluded by history and stool examination. RESULTS: The mean serum IgE level was 473.5 IU/L with a standard deviation of 671.4 IU/L (range: 15.9~2000 IU/L) and increased serum IgE levels ( > 200 IU/L) were found in 38.5% of the study population. The mean serum IgG, IgA and IgM levels were 1,939.5 +/- 588.6 mg/dL (normal: 751~1,560 mg/dL), 388.9 +/- 216.7 mg/dL (normal: 82~453 mg/dL) and 153.6 +/- 75.3 mg/dL (normal: 46~304 mg/dL), respectively. The CD4+ T cell count was inversely correlated to the serum IgE level (r=-0.429, p < 0.05), but not to the other isotypes of immunoglobulin. CONCLUSION: Serum IgE levels are increased in adults with HIV infection and could be useful as a marker of disease progression. Further study is needed to elucidate the causes and clinical significance of these findings.
Adult ; CD4 Lymphocyte Count ; Eosinophils ; Female ; HIV Infections/*immunology/virology ; Human ; Immunoglobulin A/blood ; Immunoglobulin E/*blood ; Immunoglobulin G/blood ; Immunoglobulin M/blood ; Korea ; Leukocyte Count ; Male ; Middle Age ; RNA, Viral/blood

PURPOSE: The H. pylori cagA gene, vacA gene and iceA gene are considered to be important virurence factors that have been implicated in the development of gastric adenocarcinoma. It was reported that the presence of IS605 elements may be responsible for rearrangements and lead to partial or total deletions of the cag pathogenicity island (PAI) and the virulence of cag PAI may be changed. However, different results regarding the association between these virulence factors and clinical disease have been reported from different geographic regions. This study evaluated the relationship between H. pylori virulence factors such as cagA, vacA, iceA, IS605 and gastric adenocarcinoma. MATERIALS AND METHODS: H. pylori isolates were obtained from 54 infected patients (24 cases of gastric adenocarcinoma, 30 cases of control). H. pylori isolates were identified by PCR with ureC gene and 16S rRNA. PCR was performed to examine cagA, vacA, iceA and IS605 genotypes. RESULTS: Significant difference was found in the negative rates of cagA between gastric adenocarcinoma group and control (62.5% vs. 33.3% P=0.033). No significant difference was found in the prevalence of iceA, vacA between gastric adenocar cinoma and control. The genotype of cagA+ vacA s1-m1 iceA1 was predominant in H. pylori isolates irrespective of the clinical outcome. IS605 in PAI was not found in gastric adenocarcinoma gruop and control. The positive rates of IS605 in genome were 33.3% in gastric adenocarcinoma group and 36.7% in control (P>0.05). In gastric carcinoma, the positive rate of cagA+/IS605- was lower than in control (12.5% vs. 40.0%, P=0.025) and the positive rate of cagA-/IS605- was higher than in control (54.2% vs. 23.3%, P=0.02). CONCLUSION: H. pylori virulence factors had not related significantly with gastric adenocarcinoma. Further study is needed to examine the specificity of H. pylori strains.
Adenocarcinoma* ; Genome ; Genomic Islands ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Polymerase Chain Reaction ; Prevalence ; Sensitivity and Specificity ; Virulence Factors ; Virulence*

BACKGROUND/AIMS: Resection of the esophagus for malignant disease or a benign stenosis, has a choice not only of palliative surgery, but also of replacement of the esophagus with a transposed stomach, jejunum, or colon. The first-line method is replacement with a tubulized stomach. The purpose of this study was to investigate the association of esophageal motor dysfunction and gastric emptying time with symptoms after esophagectomy. METHODS: We performed the esophageal manometry and gastric emptying time after esophagectomy for esophageal cancer in 12 patients and for benign esophageal disease in 2 patients. RESULTS: In manometric studies, a zone of high pressure in the esophago-gastric anastomosis distal to the upper esophageal sphincter was associated with symptoms after esophagectomy. The gastric emptying rate was slowed in 7 out of 14 patients, but not associated with symptoms after esophagectomy. CONCLUSIONS: Our data suggest that a high-pressure zone distal to the upper esophageal sphincter was associated with symptoms after esophagectomy in manometric study. The gastric emptying rate was not associated with postoperative symptoms.
Colon ; Constriction, Pathologic ; Esophageal Diseases ; Esophageal Neoplasms ; Esophageal Sphincter, Upper ; Esophagectomy* ; Esophagus ; Gastric Emptying* ; Humans ; Jejunum ; Manometry* ; Palliative Care ; Stomach

Emphysematous prostatic abscess is a very rare form of prostatitis. Emphysematous prostatic abscess due to Klebsiella pneumoniae may have a poor prognosis according to a few previous reports. We report a rare case of successfully treated emphysematous prostatic abscess with cystitis due to Klebsiella pneumoniae in a 50-yr-old man with 15-yr history of diabetes mellitus. The patient was referred to the emergency room of our hospital. The KUB film revealed gas shadows in the lower pelvic area suggestive of emphysematous cystitis or emphysematous prostatic abscess. The gas was mainly occupying the prostate and was also seen in the bladder on pelvic CT. The patient was successfully treated with long-term antibiotic use and additional percutaneous drainage of the abscess. Emphysematous prostatic abscess may be misdiagnosed as emphysematous cystitis due to the similar location of gas shadows on radiography. Computerized tomography and transrectal ultrasonography are helpful in making the diagnosis of emphysematous prostatic abscess. Appropriate use of effective antibiotics with drainage of pus is the best treatment. This case emphasizes the importance of timely and accurate diagnosis followed by appropriate treatment in emphysematous prostatic abscess in diabetic patients.
Abscess ; Anti-Bacterial Agents/therapeutic use ; Cystitis/diagnosis ; Diabetes Mellitus/complications ; Drainage ; Emphysema/diagnosis/*microbiology ; Human ; Klebsiella Infections/*diagnosis/drug therapy ; Klebsiella pneumoniae/*metabolism ; Male ; Middle Aged ; Prostate/*microbiology ; Prostatic Diseases/*diagnosis/microbiology/radiography