Communication between coronary arteries and cardiac chambers or large vessels is unusual type of congenital malformation. Aneurysmal formation of a coronary arteriovenous fistula is even rare. We report a case of 83-year-old women with giant aneurysm of the coronary arteriovenous fistula from the left anterior descending coronary artery treated by percutaneous deployment of embolization coil.
Aged, 80 and over ; Aneurysm* ; Arteriovenous Fistula* ; Coronary Vessels ; Embolization, Therapeutic ; Female ; Humans

OBJECTIVES: Obstructive sleep apnea (OSA) syndrome is diagnosed through history, physical examination, imaging studies and polysomnography. Clinical examination of this condition may point to hypertrophic tonsils and crowded oropharynx. The objective of this study is to investigate the usefulness of modified Mallampati grade (MMG) and tonsil grade (TG) in predicting the severity of obstructive sleep apnea. METHODS: MMG and TG were divided into 4 and 5 groups, respectively, according to their severity. Medical records were collected from 94 patients who had received polysomnography and otorhinolaryngologic examination for snoring and sleep apnea at Keimyung University Dongsan Medical Center from March 2002 through April 2004. Patients were divided into two groups according to the apnea-hypopnea index (AHI) : control (n=24), and patients with sleep apnea (n=70). RESULTS: Patients with higher MMG and TG had higher AHI, and MMG and TG proved to have a statistically significant correlation with AHI (p< 0.05) CONCLUSION: MMG and TG were reliable predictors of OSA and helpful parameters in deciding treatment method.
Humans ; Medical Records ; Oropharynx ; Palatine Tonsil ; Physical Examination ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring

Neonatal acute suppurative parotitis is rare. Staphylococcus aureus is the most common pathogen and antibiotic treatment is the first line therapy. Here, we report a case of acute suppurative parotitis caused by Escherichia coli in a 7­day­old male with febrile sensation, parotid swelling, and purulent discharge from the Stensen duct who was treated successfully with intravenous antibiotics. To the best of our knowledge, this is the first case of neonatal suppurative parotitis caused by E. coli in Korea.

BACKGROUND: The start-up behavior of syringe and syringe pump is known to be one of the causes of inaccurate intravenous infusion. This study evaluated the method of priming the infusion system (PRIMING), and its impact on the target-controlled infusion (TCI) of two remifentanil diluents. METHODS: PRIMING was performed using an evacuation of 2.0 ml to the atmosphere prior to TCI. Forty-eight TCI, using 50 microg/ml (Remi50) or 20 microg/ml (Remi20) of diluents, were performed targeting 4.0 ng/ml of effect-site concentration (Ceff), with PRIMING or not. The gravimetrical measurements of the delivered infusates reproduced actual Ceff. The bolus amount and time to reach 95% target were compared. RESULTS: Without PRIMING, Remi50 infused less bolus (43 +/- 23 %) than Remi20 (19 +/- 9 %) (P = 0.003), and showed more delayed increase of Ceff (11.2 +/- 4.0 min) than Remi20 (7.4 +/- 0.4 min) (P = 0.028). However, PRIMING significantly decreased the deficit of the bolus (2 +/- 1%), as well as the delay of the increase of Ceff in Remi50 (1.2 +/- 0.2 min) (both P < 0.001). In addition, with PRIMING, the start-up bolus showed minimal difference to the nominal bolus (1 and 2%), and Ceff were increased to 4.0 +/- 0.1 ng/ml at the expected time of peak effect, irrespective of the diluents. CONCLUSIONS: Proper operation of the syringe pump used in the priming of the syringe may be helpful in reduction of the inaccuracy of TCI, particularly during the early phase of infusion, or the infusion of a more concentrated diluent.
Atmosphere ; Infusions, Intravenous ; Piperidines ; Syringes

Although technological advances and clinical studies on stem cells have been increasingly reported in stroke, research targeting hemorrhagic stroke is still lacking compared to that targeting ischemic stroke. Studies on hemorrhagic stroke are also being conducted, mainly in the USA and China. However, little research has been conducted in Korea. In reality, stem cell research or treatment is unfamiliar to many domestic neurosurgeons. Nevertheless, given the increased interest in regenerative medicine and the increase of life expectancy, attention should be paid to this topic. In this paper, we summarized pre-clinical rodent studies and clinical trials using stem cells for hemorrhagic stroke. In addition, we discussed results of domestic investigations and future perspectives on stem cell research for a better understanding.

STUDY DESIGN: A retrograde study of metal failures at thoracolumbar spinal fractures fixed using pedicle screws. OBJECTIVES: The predictability and usefulness of the McCormack's classifications for metal failures was compared with Magerl's classifications. SUMMARY OF LITERATURE REVIEW: The load sharing classification was introduced to predict metal failure after short-segmental pedicle screw fixation by McCormack. However, its reliability is uncertain. MATERIALS AND METHODS: From July 2000 to July 2003, this study examined the plain radiographs and CT images of 31 out of 46 patients who underwent posterior stabilization using pedicle screws for thoracolumbar fractures and could be followed up at least 1 year. Fractures were classified utilizing Denis's, Magerl's, and McCormack's systems. RESULTS: As a result of analysis of relation between metal failure and classification system by Magerl or McCormack, there was no significant difference in its distribution. There was no correlation between the fixation range and metal failures in type C3 fractures, but there was a correlation between short fixation and metal failures in rotational burst fractures in short fixation. CONCLUSIONS: In order to prevent metal failures after fixing thoracolumbar spinal fractures by pedicle screws, the stability should be evaluated using Magerl's classification and McCormack's total score. In addition, in cases of type C3 fractures according to the Magerl's classification, reconstructions should be carried out with a long segment fixation or anterior supporting bone grafts, particularly when McCormack's total score is greater than 7.
Humans ; Spinal Fractures ; Spine ; Transplants

OBJECTIVES: To report two cases of neuropathy due to methyl bromide intoxication. METHODS: Workers, engaged in the fumigating process, complained fatigue, general weakness, ataxia, and hypersomnia. We evaluated them with blood tests, neurophysiologic studies and MRI and investigated their occupational history. RESULTS: Increased signal intensities were found in the medulla oblongata and paraver mian of cerebellum in MRI and after 11 days, high signal intensities were reduced in the following MRI. In the other case, polyneuropathy and rlght lower brainstem lesion were observed In the NCV and BAEP studies. CONCLUSIONS: We confirmed that worker's symptoms were related to methyl bromide exposure in the fumigation. It is necessary that we should evaluate present condition of fumigating process and prepare appropriate methods to protect workers engaged in the fumigation.
Ataxia ; Brain Stem ; Cerebellum ; Disorders of Excessive Somnolence ; Fatigue ; Fumigation* ; Hematologic Tests ; Magnetic Resonance Imaging ; Medulla Oblongata ; Polyneuropathies

PURPOSE:Carotid endarterectomy may benefit patients with bilateral carotid stenosis by improving cerebrovascular hemodynamics of ipsilateral as well as contralateral cerebral hemispheres. We investigated cerebrovascular hemodynamics after carotid endarterectomy in patients with contralateral carotid occlusion by acetazolamide stress brain SPECT. MATERIALS AND METHODS: Subjects were 14 symptomatic patients (all men, mean age 66 yrs) with carotid stenosis (> 50%) with contralateral carotid occlusion. Acetazolamide stress Tc-99m ECD brain SPECTs were performed within 2 weeks before and after carotid endarterectomy using one day protocol. Cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were assessed visually. In 12 patients, correlation between the patency of proximal anterior cerebral or anterior communicating arteries (A1/A-comm) and the improvement of CBF or CVR after endarterectomy was assessed. RESULTS: Preoperative SPECT showed reduced CBF in 2 ipsilateral and 10 contralateral hemispheres. CVR was reduced in 4 ipsilateral and 9 contralateral hemispheres. Of 12 hemispheres with reduced CBF, 2 hemispheres (16.7%) showed improvement of CBF after endarterectomy. However, reduced CVR was improved in all 4 ipsilateral and 7 of 9 (78%) of contralateral hemispheres after endarterectomy. Three of 4 with stenotic A1/A-comm and 4 of 8 with patent A1/A-comm had reduced contralateral CVR. Reduced contralateral CVR improved in all 3 patients with stenotic A1/A-comm and 3 of 4 with patent A1/A-comm. CONCLUSION: Acetazolamide stress brain SPECT demonstrated improvement of compromised cerebrovascular reserve in not only ipsilateral but also contralateral hemispheres of patients with contralateral carotid occlusion after carotid endarterectomy, and may, therefore, be useful for evaluating cerebral blood flow and cerebrovascular reserve after carotid endarterectomy.
Acetazolamide* ; Arteries ; Brain Ischemia ; Brain* ; Carotid Stenosis* ; Cerebrum ; Endarterectomy ; Endarterectomy, Carotid* ; Hemodynamics ; Humans ; Male ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Inguino-femoral hernias in women are less common than that in a man, and we have had limited experience for hernia repair in women. The purpose of this study was to evaluate the characteristics of inguino-femoral hernias in females and to establish the choice of specific treatment for inguino-femoral hernia in females. METHODS: This retrospective study was based on the medical records of 566 patients who underwent 657 cases of herniorrhaphies for treating inguino-femoral hernia in adult females from January 1998 to June 2006. We evaluated the incidence of hernia, the operative technique and the length of the operation, the complications and the postoperative recurrence rate. The operative findings and median time to reoperation for a recurrent hernia were also evaluated. RESULTS: During the 8.5-year period, we performed 2,931 herniorrhaphies in 2,274 patients. Of these, 657 herniorrhaphies were done in females (22.4%). The types of hernia in females were indirect inguinal hernia (67.3%), direct inguinal hernia (10.2%), the pantaloon type (10%) and femoral hernia (14.9%). Femoral hernia was more frequent in females (14.9%) compared to males (3.5%) (P<0.001). The overall rate of reoperation due to incarceration in the females was higher (2.5%) than that in the men (1.1%)(P<0.001). Femoral hernias in females was found at reoperation in 39.7% compared with 17.2% in the males (P<0.001). CONCLUSION: The incidence of inguino-femoral hernia in females was higher than the results of most published studies and the reoperation rate was higher in females. The increased frequency of femoral hernia at reoperation in females suggests avoiding injuries to the posterior wall of the inguinal canal and the need for exploration of the femoral canal at the time of the primary operation.
Adult ; Female ; Hernia* ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Incidence ; Inguinal Canal ; Male ; Medical Records ; Recurrence ; Reoperation ; Retrospective Studies

BACKGROUND: It is important that proper protocols are in place for trauma patients who require massive transfusion upon arrival at the emergency department. This study is a preliminary analysis of massive transfusion cases at the emergency department of our institution aimed to review the characteristics and situations in which massive transfusion occurs in an effort to better manage trauma patients receiving massive transfusion in the emergency department. METHODS: This study was conducted at the Department of Emergency Medicine in the Korea University Guro Hospital. We retrospectively reviewed the medical charts of trauma-related patients who required massive blood transfusions between January 2013 and December 2015. The inclusion criteria were as follows: patients who were over the age of 18 years and received more than 4 packed RBC (pRBC) units per hour, or 10 or more pRBC units during a period of 24-hours. RESULTS: A total of 669 patients were included in the study. There were significant differences of initial systolic blood pressure (P<0.0001), diastolic blood pressure (P<0.0001), and Injury Severity Score (P<0.0001) between those who survived and those who expired. CONCLUSION: Proper initial resuscitation is essential for the improvement of outcome in trauma patients that require a massive transfusion. The findings from this study may serve as preliminary data in developing proper transfusion protocols for massive transfusion among trauma patients.
Blood Pressure ; Blood Transfusion ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Injury Severity Score ; Korea ; Multiple Trauma ; Resuscitation ; Retrospective Studies ; Transfusion Reaction