PURPOSE: To assess the prognostic value of computed tomography (CT) in acute pancreatitis, initial CT examinations were classified into 5 grades in terms of the degree of disease severity and CT findings were correlated with clinical course, objective prognostic signs, and complications. MATERIALS AND METHODS: In 29 consecutive patients with acute pancreatitis, the CT examination and clinical course were reviewed without knowledge of each other finding. Both Ranson's prognostic signs and modified Glascow prognostic signs were used for evaluation of acute pancreatitis. RESULTS: Of the 29 patients, 25 patients recovered with medical treatment while 4 patients (14%) developed pseudocysts and the other 4 patients (14%) developed abscesses. CT findings of the acute pancreatitis are as follows; 10 patients (35%) in grade A with normal pancreas, 2 patients (7%) in grade B with pancreatic enlargement, 2 patients (7%) in grade C with intrinsic pancreatic abnormalities associated with haziness, 3 patients (10%) in grade D with single, ill-defined fluid collection, and 12 patients (41%) in grade E with extensive and two or multiple fluid collections or presence of gas in or adjacent to the pancreas. Correlation coefficient is 0.46 (p=0.012) between CT findings and Ranson's prognostic signs, 462 (p=0.0115) between CT findings and modified Glascow prognostic signs. CONCLUSION: CT gradings of acute pancreatitis may be useful in predicting clinical course.
Abscess ; Humans ; Pancreas ; Pancreatitis*

OBJECTIVE: The aim of this study was to investigate the correlation between meteorological factors and occurrence of spontaneous intracerebral hemorrhage (ICH) according to age. MATERIALS AND METHODS: We retrospectively analyzed the records of 735 ICH patients in a metropolitan hospital-based population. Observed and expected numbers of ICH patients were obtained at 5degrees C intervals of ambient temperature and a ratio of observed to expected frequency was then calculated. Changes in ambient temperature from the day before ICH onset day were observed. The Wilcoxon-Mann-Whitney test was used to test differences in meteorological variables between the onset and non-onset days. The Kruskal-Wallis test was used for comparison of meteorological variables across gender and age. RESULTS: ICH was observed more frequently (observed/expected ratio > or = 1) at lower mean, minimum, and maximum ambient temperature (p = 0.0002, 0.0003, and 0.0002, respectively). Significantly lower mean, minimum, and maximum ambient temperature, dew point temperature, wind speed, and atmospheric pressure (p = 0.0003, 0.0005, 0.0001, 0.0013, 0.0431, and 0.0453, respectively) was observed for days on which spontaneous ICH occurred. In the subgroup analysis, the ICH onset day showed significantly lower mean, minimum, and maximum ambient temperature, dew point temperature, relative humidity, and higher atmospheric pressure in the older (> or = 65 years) female group (p = 0.0093, 0.0077, 0.0165, 0.0028, 0.0055, and 0.0205, respectively). CONCLUSION: Occurrence of spontaneous ICH is closely associated with meteorological factors and older females are more susceptible to lower ambient temperature.
Atmospheric Pressure ; Cerebral Hemorrhage* ; Female ; Humans ; Humidity ; Meteorological Concepts* ; Meteorology ; Retrospective Studies ; Wind

PURPOSE: Total knee replacement is one of the most painful orthopedic procedures, and effective pain relief is essential for early mobility and discharge from hospital. The aim of this study was to evaluate whether addition of single-injection femoral nerve block to epidural analgesia would provide better postoperative pain control, compared to epidural analgesia alone, after total knee replacement. MATERIALS AND METHODS: Thirty-eight patients received a single-injection femoral nerve block with 0.25% levobupivacaine (30 mL) combined with epidural analgesia (femoral nerve block group) and 40 patients received epidural analgesia alone (control group). Pain intensity and volume of patient-controlled epidural analgesia medication and rescue analgesic requirements were measured in the first 48 hours after surgery at three time periods; 0-6 hours, 6-24 hours, and 24-48 hours. Also, side effects such as nausea, vomiting, and pruritus were evaluated. RESULTS: Median visual analog scale at rest and movement was significantly lower until 48 hours in the femoral nerve block group. Patient-controlled epidural analgesia volume was significantly lower throughout the study period, however, rescue analgesia requirements were significantly lower only up to 6 hours in the femoral nerve block group. The incidences of nausea and vomiting and rescue antiemetic requirement were significantly lower in the femoral nerve block group up to 6 hours. CONCLUSION: The combination of femoral nerve block with epidural analgesia is an effective pain management regimen in patients undergoing unilateral total knee replacement.
Aged ; Analgesia, Epidural/*methods ; Analgesia, Patient-Controlled/*methods ; Anesthetics, Local/administration & dosage/therapeutic use ; Arthroplasty, Replacement, Knee/*methods ; Bupivacaine/administration & dosage/analogs & derivatives/therapeutic use ; Female ; Femoral Nerve/*drug effects ; Humans ; Injections ; Male ; Middle Aged ; Nerve Block/*methods

Primary cutaneous CD30-positive large cell lymphoma and lymphomatoid papulosis; both entities are characterized by CD30-positive large atypical cells predominantly of T cell origin. We report a borderline case between CD30-positive large cell lymphoma and lymphomatoid papulosis in a 57-year-old woman presenting as a spontaneous disappearing and recurrent solitary erosive nodule on the right upper eyelid. Histopathological findings of two biopsies from each lesion showed mixed CD30-positive large atypical cells, many eosinophils and neutrophils histologically. The nodule disappeared after chemotherapy and subsequent radiotherapy. She is well without recurrence for a follow-up of 9 months.
Biopsy ; Drug Therapy ; Eosinophils ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphomatoid Papulosis ; Lymphoproliferative Disorders* ; Middle Aged ; Neutrophils ; Radiotherapy ; Recurrence

PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) has recently been clinically applied in the treatment of drug resistant depressed patients. There are mixed findings about the efficacy of rTMS on depression. Furthermore, the influence of rTMS on the physiology of the brain is not clear. We prospectively evaluated changes of regional cerebral blood flow (rCBF) between pre- and post-rTMS treatment in patients with drug resistant depression. MATERIALS AND METHODS: Twelve patients with drug-resistant depression (7 male, 5 female; age range: 19~52 years; mean age: 29.3+/-9.3 years) were given rTMS on right prefrontal lobe with low frequency (1 Hz) and on left prefrontal lobe with high frequency (20 Hz), with 20-minute-duration each day for 3 weeks. Tc-99m ECD brain perfusion SPECT was obtained before and after rTMS treatment. The changes of cerebral perfusion were analyzed using statistical parametric mapping (SPM; t=3.14, uncorrected p<0.01, voxel=100). RESULTS: Following areas showed significant increase in rCBF after 3 weeks rTMS treatment: the cingulate gyrus, fusiform gyrus of right temporal lobe, precuneus, and left lateral globus pallidus. Significant decrement was noted in: the precental and middle frontal gyrus of right frontal lobe, and fusiform gyrus of left occipital lobe. CONCLUSION: Low-frequency rTMS on the right prefrontal cortex and high-frequency rTMS on the left prefrontal cortex for 3 weeks as an add-on regimen have increased and decreased rCBF in the specific brain regions in drug-resistant depressed patients. Further analyses correlating clinical characteristics and treatment paradigm with functional imaging data may be helpful in clarifying the pathophysiology of drug-resistant depressed patients.
Brain ; Depression ; Female ; Frontal Lobe ; Globus Pallidus ; Gyrus Cinguli ; Humans ; Male ; Occipital Lobe ; Perfusion ; Physiology ; Prefrontal Cortex ; Prospective Studies ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon ; Transcranial Magnetic Stimulation*

BACKGROUNDS: There are recently increasing reported cases of patients with malignant lymphoma with unique characteristics, designated nasal-type T/natural killer (NK) cell lymphoma (NKTL), which usually expresses the NK cell marker and shows frequent extra-nodal involvement including skin and poor prognosis. The CD56+ NKTL can be divided into nasal and non-nasal types. Nasal and non-nasal (nasal type) CD56+ NKTL share the same pathologic features such as angiocentricity and necrosis. OBJECTIVE: We have studied clinicopathologic features of 5 cases of nasal CD56+ NKTL with cutaneous involvement to further elucidate the behaviour of nasal CD56+ NKTL. RESULTS: Clinically, the cutaneous lesions were variable. Four of the five cases died with rapidly progressive disease within 25 months. Histologically, variable sized pleomorphic lymphoid cells with or without prominent angiodestruction were observed. Severe necrosis was consistent features. The results of immunophenotypes(both CD56+ and CD3+) and TCR gene rearrangement study showed these 5 cases are of NK cell origin(4 cases) or NK-like T-cell origin (1 case). A firm association with Epstein-Barr virus (EBV) infection was confirmed in our study. CONCLUSION: Although the prognosis of nasal CD56+ NKTL was not so bad, higher stage of nasal CD56+ NKTL with cutaneous metastasis seemed to be very fatal. The term NKTL has to be further specified according to immunophenotypes such as CD56+ or true T-cell, NK-like T cell lymphoma since biologic behaviour of each subgroup can be different.
Genes, T-Cell Receptor ; Herpesvirus 4, Human ; Humans ; Killer Cells, Natural ; Lymphocytes ; Lymphoma* ; Lymphoma, T-Cell ; Necrosis ; Neoplasm Metastasis ; Prognosis ; Skin ; T-Lymphocytes

Low grade MALT lymphoma of stomach is associated with H. pylori infection in more than 90% of cases, and eradication of H. pylori leads to regression of the low grade MALT lymphoma in 60~90% of cases. On the contrary, high grade MALT lymphoma is thought to be independent from H. pylori for growth and usually is thought to require antitumor chemotherapy. However, there have been recent reports of high grade MALT lymphoma regressing after H. pylori eradication. We experienced and are reporting a case of high grade MALT lymphoma arising in the background of low grade MALT lymphoma that showed complete regression after H. pylori eradication.
Drug Therapy ; Helicobacter pylori* ; Helicobacter* ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Stomach

We report an unusual case of primary cutaneous CD30+ anaplastic large cell lymphoma in a 58-year-old man who presented with disseminated hyperpigmented patches, papules, and nodules. Our case is also unusual in that the patient did not respond to an intensive chemotherapy regimen in contrast to previously reported cases of primary cutaneous CD30+ anaplastic large cell lymphoma.
Drug Therapy ; Humans ; Lymphoma, Large-Cell, Anaplastic* ; Middle Aged

PURPOSE: This study was performed to find the chief clinical problems associated with the ages of adult patients of tetralogy of Fallot(TOF) who had undergone total correction. METHODS: Of the 30 patients who were registered at the Grown-Up Congenital Heart Disease (GUCH) Clinic of Samsung Medical Center for TOF, a retrospective investigation was carried out on 28 patients who underwent total correction. RESULTS: Mean age at retrospective study was 30.8(range : 16-53) years old. Age at total correction was 15.8(range : 2-49) years old. Problems after corrective surgery were assessed. They were arrhythmia, pulmonary valve regurgitation, left pulmonary artery stenosis, residual ventricular septal defect, mitral valve regurgitation, tricuspid valve regurgitation, right ventricle outflow tract obstruction, aortic valve regurgitation, infective endocarditis and protein losing enteropathy. After repair of TOF, such arrhythmias as atrial arrhythmia and AV conduction disturbances were observed in some patients. Cardiomegaly was found significantly in the subjects with arrhythmia(P<0.05), and arrhythmia was less observed in patients who underwent surgery at a young age. Eight patients required a reoperation; the main indications were residual ventricular septal defect, right ventricle outflow tract obstruction and peripheral pulmonary artery stenosis. CONCLUSION: The majority of the patients seemed to live normal lives after Tetralogy of Fallot repair. However, as residual anatomic and functional abnormalities exist postoperatively, continued careful follow-up is needed to detect and correct structural and functional abnormalities.
Adult* ; Aortic Valve ; Arrhythmias, Cardiac ; Cardiomegaly ; Constriction, Pathologic ; Endocarditis ; Follow-Up Studies* ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Mitral Valve Insufficiency ; Protein-Losing Enteropathies ; Pulmonary Artery ; Pulmonary Valve Insufficiency ; Reoperation ; Retrospective Studies ; Tetralogy of Fallot* ; Tricuspid Valve Insufficiency

OBJECTIVE: We performed this study to evaluate the effects of Sil-Select and Percoll in sperm preparation. METHODS: Semen samples of 22 patients with normal sperm parameters by WHO criteria were divided into two equal parts and prepared with Percoll and Sil-Select. After completion of semen preparation procedures with Percoll and Sil-Select, sperm concentration, motility and morphology using strict criteria were evaluated in each group and all semen samples were fixed and stained for transmission electron microscopy(TEM). RESULTS: There were no significant diffrences in sperm concentration, percentage of motile spermatozoa and percentage of normal spermatozoa in morphology evaluation using strict criteria under light microscopy between Percoll and Sil-Select-treated groups. However, the percentage of normal shape and position of acrosome, and normal helix assembly of mitochondria under TEM were significantly higher in the Sil-Select-treated group compared to Percoll-treated group (p < 0.001, p < 0.001, p < 0.001). CONCLUSIONS: These data demonstrate that Sil-Select is less detrimental to the acrosome and mitochondria of spermatozoa in sperm preparation compared to Percoll.
Acrosome ; Humans ; Male ; Microscopy ; Microscopy, Electron, Transmission ; Mitochondria ; Semen ; Spermatozoa*