No abstract available.

Several approaches to the cerebellopontine angle and internal auditory canal have been described for the removal of large acoustic tumors. Of these, the translabyrinthine removal of the large cerebellopontine angle tumors requires extensive removal of bones in order to manage the low-lying tegmen, the anterior sigmoid sinus, and the high jugular bulb. We removed 4 large cerebellopontine angle tumors by the translabyrinthine approach alone. All tumors were totally removed with acceptable facial nerve function. There was a case of CSF leak which was repaired at the revision surgery.
Cerebellopontine Angle* ; Colon, Sigmoid ; Facial Nerve ; Neuroma, Acoustic*

OBJECTIVE: To investigate the length of hospital stay (LOS) after stroke using the database of the Korean Health Insurance Review & Assessment Service. METHODS: We matched the data of patients admitted for ischemic stroke onset within 7 days in the Departments of Neurology of 12 hospitals to the data from the database of the Korean Health Insurance Review & Assessment Service. We recruited 3,839 patients who were hospitalized between January 2011 and December 2011, had a previous modified Rankin Scale of 0, and no acute hospital readmission after discharge. The patients were divided according to the initial National Institute of Health Stroke Scale score (mild, ≤5; moderate, >5 and ≤13; severe, >13); we compared the number of hospitals that admitted patients and LOS after stroke according to severity, age, and sex. RESULTS: The mean LOS was 115.6±219.0 days (median, 19.4 days) and the mean number of hospitals was 3.3±2.1 (median, 2.0). LOS was longer in patients with severe stroke (mild, 65.1±146.7 days; moderate, 223.1±286.0 days; and severe, 313.2±336.8 days). The number of admitting hospitals was greater for severe stroke (mild, 2.9±1.7; moderate, 4.3±2.6; and severe, 4.5±2.4). LOS was longer in women and shorter in patients less than 65 years of age. CONCLUSION: LOS after stroke differed according to the stroke severity, sex, and age. These results will be useful in determining the appropriate LOS after stroke in the Korean medical system.
Female ; Humans ; Insurance, Health ; Length of Stay* ; Neurology ; Patient Acuity ; Patient Readmission ; Stroke*

Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5degrees C. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation.
Adolescent ; Anal Canal ; Body Temperature ; Cicatrix ; Colon, Sigmoid ; Colostomy ; Constipation ; Constriction, Pathologic ; Emergencies ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Intestinal Perforation ; Sclerotherapy

PURPOSE: Vesicoureteral reflux(VUR) is the major risk factor of urinary tract infection(UTI) in children and may result in serious complications such as renal scarring and chronic renal failure. The purpose of this study was to evaluate the relationship between VUR and renal scar formation, the usefulness and correlation of various imaging studies in reflux nephropathy, and the spontaneous resolution of VUR. METHODS: We retrospectively reviewed 106 patients with VUR with no accompanying urogenital anomalies in the Department of Pediatrics, Bundang CHA Hospital during the period from Jan. 1996 to Mar. 2005. Ultrasonography and 99mTc-dimercaptosuccinic acid(DMSA) scan were performed in the acute period of UTI. Voiding cystourethrography(VCUG) was performed 1 to 3 weeks after treatment with UTI. Follow-up DMSA scan was performed 4 to 6 months after treatment and a follow-up VCUG was performed every 12 months. RESULTS: The mean age at detection of VUR was 13.8+/-22.2 months and the male to female ratio was 2:1. The incidence of renal scarring showed a tendency of direct correlation between severity of VUR(P<0.001) and abnormal findings of renal ultrasonography(P<0.01). 63.2%(24 of 38 renal units) of renal parenchymal defects present in the first DMSA scan disappeared on follow-up DMSA scans. Follow-up DMSA scans detected renal scars in 7(14%) of 50 renal units with ultrasonographically normal kidneys. Meanwhile, ultrasonography did not show parenchymal defects in 7(36.8%) of 19 renal units where renal scarring was demonstrated on a follow-up DMSA scan. The spontaneous resolution rate of VUR was higher(75%) in cases with low grade(I to III) VUR(P<0.01). CONCLUSIONS: The presence and severity of VUR and abnormal findings of renal ultrasonography significantly correlated with renal scar formation. DMSA scan was useful in the diagnosis of renal defects. Meanwhile renal ultrasonography was an inadequate method for evaluating renal parenchymal damage. Therefore, follow-up DMSA scans should be performed to detect renal scars even in children with low-grade VUR and normal renal ultrasonography.
Child ; Cicatrix* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Kidney Failure, Chronic ; Male ; Pediatrics ; Retrospective Studies ; Risk Factors ; Succimer ; Ultrasonography ; Urinary Tract ; Vesico-Ureteral Reflux*

PURPOSE: To characterize the MR findings for a differential diagnosis and to make a plan for treatment by interventional technique of the vascular masses with/without hypertrophic feeding vessels of the head and neck. SUBJCETS AND METHODS: Seven patients with vascular masses of the head and neck proved by pathology, angiography, clinical findings were included. Vascular masses included 4 venous malformations, a capillary hemangioma, and a hemangiopericytoma, a hemangioma combined with arteriovenous malformation. 7 patients had MR studies with 1.0T and 1.5T using routine TI-, T2- weighted spin echo sequences, and contrast enhancement. 4 MR angiography, 3 inversion recovery, and 6 contrast angiography were studied from 7 patients RESULTS: All vascular masses demonstrated higher than muscle signal intensity on Tl-weighted images, bright signal intensity on T2-weighted images, and prominent enhancement, except AV hemangioma combined with prominent arteriovenous malformation on postcontrast scan. Three hemangiomas demonstrated distinct serpiginous signal voids. Venous malformations demonstrated venous lakes seen as homogenous regions of high signal intensity and phleboliths seen as low signal foci on images. Inversion recovery was the best pulse sequence for evaluation of the extent of lesion. CONCLUSION: MR findings of the vascular masses of the head and neck are useful in delineating the extent of the disease, differentiating venous malformation or cavernous hemangioma from other hemangiomatous lesions including hypertrophic feeding vessels, and making a plan for treatment by interventional technique also.
Angiography ; Arteriovenous Malformations ; Diagnosis, Differential* ; Head* ; Hemangioma ; Hemangioma, Capillary ; Hemangioma, Cavernous ; Hemangiopericytoma ; Humans ; Lakes ; Neck* ; Pathology

Wound healing of the skin and soft tissue defect is accomplished by generation of granulation tissue, collagen synthesis, contraction and re-epithelization. In the full-thickness skin wound, contraction plays an important role and fundamental principles in the treatment of infected wounds include the elimination of infection, the evacuation of pus, and the debridement of all necrotic material. The natural healing process of infected wounds can be expedited by the application of agents which will effectively eliminate infection with facilitating the healing process. Yunkyo is one of the most commonly used oriental herb medicine which is known to be effective in wound healing. In order to evaluate the effects of Yunkyo over wound healing and inhibition of bacterial growth, the author counted the bacterial colony in vitro and made skin defect on the back of rats for the comparison of reduced wound size and changes of tissue bacterial colony count after treatmnet with Solcoseryl, TCDO (Tetra-chloro-deca-oxide) and povidone. The results were obtained as follows: Calculating colony count in vitro, Yunkyo treated group was the most effective(p<0.001). There were significant differences between Yunkyo treated and control group in wound healing(p<0.001): Yunkyo healed the wound more rapidly. Calculating tissue bacterial colony count in open infected wound, Yunkyo treated group was showed the lowest colony count. In microscopic findings, the author observed marked growth of the granulation tissue, infiltration of the inflammatory cells, development of capillaries and even arrangement of collagen in Yunkyo treated groups than in the control group. In electron microscopy, abundant protein synthesis and myofilament in the myofibroblast were observed, and the authors found active wound contraction and the growth of granulation tissue. In conclusion, the Yunkyo has remarkable antibiotic effect and promotes wound contraction and the growth of granulation tissue in the process of wound healing.
Actihaemyl ; Animals ; Capillaries ; Collagen ; Debridement ; Granulation Tissue ; Microscopy, Electron ; Myofibrils ; Myofibroblasts ; Povidone ; Rats* ; Skin ; Suppuration ; Wound Healing* ; Wounds and Injuries*

The occurrence of a trigeminal neuropathy associated with connective tissue disease is rare. Trigeminal neuropathy in connective tissue disease is predominantly sensory and it is characterized by numbness, hypesthesia, slurred speech, and touch pain. Although the pathogenesis of trigeminal neuropathy associated with connective tissue disease remains obscure, the main pathologic findings are vasculitis and neuritis. A case of trigeminal neuropathy associated with mixed connective tissue disease is described, and the incidence, symptoms, pathophysiology, treatment of the disease is discussed.
Connective Tissue Diseases ; Hypesthesia ; Incidence ; Mixed Connective Tissue Disease* ; Neuritis ; Trigeminal Nerve Diseases* ; Vasculitis

PURPOSE: Radiation-induced autophagy has been shown to play two different roles, in malignant glioma (MG) cells, cytocidal or cytoprotective. However, neither the role of radiation-induced autophagy for cell death nor the existence of autophagy-induced apoptosis, a well-known cell-death pathway after irradiation, has been verified yet. MATERIALS AND METHODS: We observed both temporal and dose-dependent response patterns of autophagy and apoptosis to radiation in MG cell lines. Additionally, we investigated the role of autophagy in apoptosis through knockdown of autophagy-related proteins. RESULTS: Autophagic activity measured by staining of acidic vesicle organelles and Western blotting of LC-3 protein increased in proportion to radiation dose from day 1 to 5 after irradiation. Apoptosis measured by annexin-V staining and Western blotting of cleaved poly(ADP-ribose) polymerase demonstrated relatively late appearance 3 days after irradiation that increased for up to 7 days. Blocking of pan-caspase (Z-VAD-FMK) did not affect apoptosis after irradiation, but silencing of Atg5 effectively reduced radiation-induced autophagy, which decreased apoptosis significantly. Inhibition of autophagy in Atg5 knockdown cells was shown to be beneficial for cell survival. Stable transfection of GFP-LC3 cells was observed after irradiation. Annexin-V was localized in cells bearing GFP-LC3 punctuated spots, indicating autophagy in immunofluorescence. Some of these punctuated GFP-LC3 bearing cells formed conglomerated spots and died in final phase. CONCLUSION: These findings suggest that autophagy appears earlier than apoptosis after irradiation and that a portion of the apoptotic population that appears later is autophagy-dependent. Thus, autophagy is a pathway to cell death after irradiation of MG cells.
Apoptosis* ; Autophagy* ; Blotting, Western ; Cell Death* ; Cell Line ; Cell Survival ; Fluorescent Antibody Technique ; Glioma* ; Organelles ; Poly(ADP-ribose) Polymerases ; Transfection

Background: The effect of intrauterine hyperglycemia on fat mass and regional fat proportion of the offspring of mothers with gestational diabetes mellitus (OGDM) remains to be determined. Methods: The body composition of OGDM (n=25) and offspring of normoglycemic mothers (n=49) was compared using dualenergy X-ray absorptiometry at age 5 years. The relationship between maternal glucose concentration during a 100 g oral glucose tolerance test (OGTT) and regional fat mass or proportion was analyzed after adjusting for maternal prepregnancy body mass index (BMI). Results: BMI was comparable between OGDM and control (median, 16.0 kg/m2 vs. 16.1 kg/m2 ). Total, truncal, and leg fat mass were higher in OGDM compared with control (3,769 g vs. 2,245 g, P=0.004; 1,289 g vs. 870 g, P=0.017; 1,638 g vs. 961 g, P=0.002, respectively), whereas total lean mass was lower in OGDM (15,688 g vs. 16,941 g, P=0.001). Among OGDM, total and truncal fat mass were correlated with fasting and 3-hour glucose concentrations of maternal 100 g OGTT during pregnancy (total fat mass, r=0.49, P=0.018 [fasting], r=0.473, P=0.023 [3-hour]; truncal fat mass, r=0.571, P=0.004 [fasting], r=0.558, P=0.006 [3-hour]), but there was no correlation between OGDM leg fat mass and maternal OGTT during pregnancy. Regional fat indices were not correlated with concurrent maternal 75 g OGTT values. Conclusion Intrauterine hyperglycemia is associated with increased fat mass, especially truncal fat, in OGDM aged 5 years.