Since a nationwide childhood vaccination with tetanus toxoid, tetanus has become a rare disease in Korea. However, we recently experienced 17 cases of adult tetanus in a university hospital during a 21-month period. Seventy percent of the patients were female, and the mean age was 63 yr (range, 29-87). The majority (88.2%) of the patients did not get primary vaccinations for tetanus and decennial tetanus-diph-theria toxoid booster. Most patients (88.2%), who sustained acute injury, did not seek medical care for their wounds or did not receive the prophylaxis for tetanus. Tetanus was found most frequently among farmers. Tetanus was diagnosed initially only in 53% of patients. The case-fatality ratio was 23.5%. These cases show that recently occurring tetanus in Korea is a disease, affecting the elderly and the female who may have a lower immunity against tetanus, and the farmers who are likely to be exposed to Clostridium tetani. In addition, diagnosis of tetanus is often delayed in area where cases are seen infrequently. Therefore, improved education among patients and physicians, emphasis of anti-tetanus immunization and awareness of tetanus respectively, may be essential for the prevention of disease and the reduction of its mortality.
Adult ; Aged ; Aged, 80 and over ; Agricultural Workers' Diseases/epidemiology ; Diagnostic Errors ; Diphtheria-Tetanus-Pertussis Vaccine ; Emergency Service, Hospital ; Health Education ; Health Knowledge, Attitudes, Practice* ; Human ; Immunization, Secondary/psychology ; Immunization, Secondary/utilization* ; Korea/epidemiology ; Middle Aged ; Tetanus/diagnosis ; Tetanus/epidemiology* ; Tetanus/prevention & control ; Tetanus/therapy ; Tetanus Antitoxin/therapeutic use ; Tetanus Toxoid ; Treatment Outcome ; Vaccination/utilization* ; Wounds, Penetrating/complications

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

No abstract available.
Cervix Uteri* ; Female ; Lymph Nodes* ; Neoplasm Metastasis*

The authors studied and analyzed microscopically the structure, length and diameter of each part of Willis circle in 264 cerebral hemispheres of 182 autopsied patients in the Taegu area from 1984 to 1990. The mean length of each A1 was 14.1mm and diameter at distal A1 was 2.25mm. The most common anatomical anomaly of the ACA part was A1 that of hypoplasia which appeared in 7.5% of the cases. The origin of the Heuner a. was accounted for the highest incidence of AcoA(82.5%). The length of AcoA. Noted 3.5mm with the incidence of duplication and triplication in 38.6%. The inner diameter of ICA noted 3.9mm at the communicating segment in ICA, and the average length of C4 was 12.5m. Except 5 hemispheres of undetectable origin at ICA, all the anterior choroidal a. originated from ICA, and the double stump of which noted 15.5%. Fetal type PcoA. Showed 6.6% of all and average length of the a. was 13.5mm. The inner diameter of MCA was 3.1mm and the mean length of M1 noted 15.5mm. The length of each P1 noted 6.95mm and the inner diameter of basilar a. at 1cm below the bifurcation was 3.3mm. The mean circumference of willis circle including both side of A1, P1, PcoA. AcoA. And choroidal and communicating segment of ICA was 88.6mm. Incidental finding of unruptured aneurysm noted 5.3% and junctional dilatation of PcoA. Showed 11.4% of all the cases.
Aneurysm ; Cerebrum ; Choroid ; Circle of Willis* ; Daegu ; Dilatation ; Humans ; Incidence ; Incidental Findings

No abstract available.
Trichosporon*

Mycobacterium avium complex (MAC) refers to infections caused by one of two nontuberculous mycobacterial species, either M. avium or M. intracellulare and the risk of MAC in patients with human immunodeficiency virus (HIV) infection increases as the CD4+ T cell number declines below 50 cells/mm3. In these patients, fever, night sweats, abdominal pain, weight loss and multiple large retroperitoneal and mesenteric lymph nodes should suggest the diagnosis of MAC infection as well as other known causes of lymphadenitis, including lymphoma, Kaposi's sarcoma, dis-seminated histoplasmosis, cryptococcosis and intraabdominal M. tuberculosis. We report an autopsy case of 55 years-old man with HIV-infection who was diagnosed mesenteric lymphadenitis due to MAC infection as a cause of fever of unknown origin during treatment of the primary central nervous system malignant B-cell lymphoma.
Abdominal Pain ; Acquired Immunodeficiency Syndrome* ; Autopsy ; Cell Count ; Central Nervous System ; Cryptococcosis ; Diagnosis ; Fever ; Fever of Unknown Origin ; Histoplasmosis ; HIV ; Humans ; Lymph Nodes ; Lymphadenitis ; Lymphoma ; Lymphoma, B-Cell ; Mesenteric Lymphadenitis* ; Middle Aged ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Sarcoma, Kaposi ; Sweat ; Tuberculosis ; Weight Loss

The incidence of synchronous gastric cancer is variously reported to be 2.07%, 5.22%, 6.5%, 8.6%, or 9% and has been increasing recently, probably with advance in the diagnosis of gastric cancer. Our case in presentation is a 70-year-old male patient who had total gastrectomy and esopbagiojunostomy done for synchronous four gastric cancer. Each has different histologic types, Some of these lesions are not suspected before operation and are found almost by chance during histologic examinations after surgery performed only to remove main lesion. So we report this case with a review of literatures.
Aged ; Diagnosis ; Gastrectomy ; Humans ; Incidence ; Male ; Stomach Neoplasms*

An esophageal perforation is a condition requiring emergency treatment. Although previously spontaneous ruptures were the most common etiology, as endoscopic and radiologic diagnosis and treatment have developed recently, iatrogenic ruptures due to instrumentation have increased to become the most common cause of esophageal perforations. Generally, the treatment of esophageal stenosis is composed of esophageal dilatation using a Maloney or a Mercury dilator and medical treatment for reflux esophagitis. Recently, balloon-catheter dilatation of the esophagus has produced safe and excellent results, and self-expansible metallic stents has been very useful in controlling malignant strictures of the esophagus with low mortality and morbidity. We experienced an esophageal perforation after balloon dilatation and the insertion of a self-expanding silicone-covered Gianturco stent to the site of the esophageal stenosis which was due to reflux esophagitis. The abdomen was opened through an upper midline incision. There was a 3-cm-long longitudinal laceration on the distal esophagus which was closed transversely as with a Heinecke-Mikulicz pyloroplasty after a debridement. To reinforce the site of esophageal laceration and to prevent esophageal reflux, the gastric fundus was pulled and sutured over the esophageal sutures, and the second-layer mattress suture was made 1 cm proximal to the first sutures, including central ligaments of the diaphragm. To prevent bile reflux, we converted from a Billroth-II to a Roux- en-Y gastrojejunostomy. We followed up for 30 months and found no signs of any esophageal stenosis or gastroesophageal reflux.
Abdomen ; Bile Reflux ; Catheters* ; Constriction, Pathologic ; Debridement ; Diagnosis ; Diaphragm ; Dilatation ; Emergency Treatment ; Esophageal Perforation* ; Esophageal Stenosis* ; Esophagitis, Peptic ; Esophagus ; Gastric Bypass ; Gastric Fundus ; Gastroesophageal Reflux ; Lacerations ; Ligaments ; Mortality ; Rupture ; Rupture, Spontaneous ; Stents* ; Sutures

BACKGROUND: Assessment of left ventricular function with conventional 2-dimensional echocardiography (2D echo) remains largely qualitative and subjective because the manual tracing of endocardial borders is laborious and tedious. An automatic border detection (ABD) echo has been recently developed that permits real-time measurements of chamber areas and cardiac function. METHODS: To determine usefulness of ABD echo, left ventricular cross-sectional areas were automatically measured from the parasternal short-axis image in 25 cases including 9 cardiac patients, and compared with those by off-line analysis of the conventional 2D echo image. RESULTS: In on-line ABD analysis, short axis end-diastolic area averaged 13.1+/-2.2cm2, end-systolic area 5.3+/-1.3cm2 and fractional area change 59.4+/-9.0% and off-line manual analysis yielded corresponding values of 14.7+/-2.5cm2, 6.2+/-1.3cm2, and 57.1+/-7.1%. The end-diastolic and end-systolic areas by both methods were significantly different, respectively. Left ventricular end-diastolic and end-systolic area and fractional area change obtained from ABD echo correlated significantly with those of off-line measurements(r=0.897, p<0.001 ; r=0.505, p<0.01 ; r=0.427, p<0.05). CONCLUSION: Thus, these facts suggest that ABD echo is useful for on-line continuous measurement of chamber areas and cardiac function.
Axis, Cervical Vertebra ; Echocardiography* ; Humans ; Ventricular Function, Left

BACKGROUND: Metabolic syndrome (MS) and homocysteine (Hcy) are known to contribute to developing atherosclerothrombosis in ischemic stroke. However, there have been controversies regarding the relationship between insulin resistance and plasma Hcy levels in healthy subjects. Our aim was to determine the possibility of a relationship between MS and elevated Hcy in ischemic stroke patients. METHODS: We investigated demographic features and risk factors in 221 patients from Gachon Stroke Registry between March 2003 and February 2004. The stroke subtypes were categorized as large artery atherosclerosis (LAA), small artery occlusion (SAO) and cardioembolism (CE). MS was defined as the followings; impaired fasting glucose, impaired glucose tolerance or IDDM with two or more among 1) hypertension (antihypertensive treatment and/or BP 160/90 mmHg), 2) dyslipidemia (TG >or=150 mg/dL and/or HDL-C (<35 in men, <39 mg/dL in women)), 3) obesity (BMI >or=25 kg/m2 or waist circumference 90 in men, 80 cm in women). RESULTS: Hcy, total cholesterol, and fibrinogen levels were higher in MS(+) than in MS(-) (p=0.026, 0.021 and 0.025). The Hcy level was higher in LAA patients than in SAO and CE patients (14.1 +/- 6.8, 12.0 +/- 6.2, 11.0 +/- 4.3 mol/L, p=0.009). It was significantly higher in MS(+) than is MS(-) in SAO patients (15.4 +/- 9.5 vs 10.5 +/- 2.9 mol/L, p=0.016), while not observed in LAA or CE patients. Among the MS(+), LAA was more prevalent (48.6%) than SAO (36.1%) and CE (15.3%). CONCLUSIONS: Elevated Hcy level may be associated with ischemic stroke with MS. Further studies remain to be investigated to clarify whether lowering the elevated Hcy can be an another important asset in reducing the risk not only for stroke, but also for MS.
Arteries ; Atherosclerosis ; Cholesterol ; Diabetes Mellitus, Type 1 ; Dyslipidemias ; Fasting ; Fibrinogen ; Glucose ; Homocysteine* ; Humans ; Hypertension ; Insulin Resistance ; Male ; Obesity ; Plasma* ; Risk Factors ; Stroke* ; Waist Circumference