Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressivebehavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proimal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.
Adult ; Angiography ; Brain ; Dexamethasone ; Diagnosis ; Disorders of Excessive Somnolence ; Follow-Up Studies ; Humans ; Hyperphagia ; Magnetic Resonance Imaging ; Meningoencephalitis* ; Middle Cerebral Artery ; Neurologic Manifestations ; Thorax ; Tuberculosis ; Tuberculosis, Meningeal ; Vasculitis

The multistage maximal exercise test was performed to 135 cases with various heart disease and 207 control group between jan. 1980 and Dec. 1980 in KoreaGeneral Hospital. The change of heart rate, blood pressure and ST segment in various heart disease were compared with those in control group. The results were followings; 1. There were 130 male and 77 female of cases with control group, whose mean age were 50 years old. 2. General check up was the most common underlying disease of control group(67 patients) and the others were gastritis (28), neurosis (24), diabets mellitus (17), hepatitis (4) and peptic ulcer (4) frequency. 3. Change of heart rate, blood pressure and ST segment in control group during GXT were 89~154, 119/80~157/88 mmHg and 0.6~2 mm. 4. There were 81 male and 51 female of cases with various heart disease group, whose mean age were 50 years old. 5. Atherosclerotic heart disease was the most common underlying disease of various heart disease group (49 patients) and the others were hypertension (34), hypertensive cardiovascular disease (22), labile hypertension (14), angina (7), arrythmia (6) and others (3) in frequency. 6. Change of heart rate, blood pressure and ST segment in various heart disease group during GXT were 85~148, 140/93~178/102 mmHg and -0.7~1.3mm. ST segment in atherosclerotic heart disease, hypertension, hypertensive cardiovascular disease, valvular heart disease and myocardial infarction were significantly depressed(p<0.05) compared with ST segment in control group.
Arrhythmias, Cardiac ; Blood Pressure ; Cardiovascular Diseases ; Exercise Test* ; Female ; Gastritis ; Heart Diseases* ; Heart Rate ; Heart Valve Diseases ; Heart* ; Hepatitis ; Humans ; Hypertension ; Male ; Middle Aged ; Myocardial Infarction ; Peptic Ulcer

There are many difficult problems of reduction and its maintaining in the treatment of unstable intertrochanteric fractures. Especially, in cases of elderly patients with marked osteoporosis, prolonged immobilization brings more serious complication. In order to solve these problems, in cases of unstable intertrochanteric fractures with large lesser trochanteric fragment, we have carried out anatomical reduction and rigid internal fixation with compression hip screw and additional transfixation screw on posteromedial fragment. The unstable fractures have been convrted into the stable fractures by transfixation screw. We analyzed the 1 1cases with additional transfixation screw and they showed good results in one year follow up.
Aged ; Femoral Fractures ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip ; Humans ; Immobilization ; Osteoporosis

Primary lateral sclerosis (PLS) is a rare upper motor neuron disease characterized by selective degeneration of corticospinal and corticobulbar tracts. It is important to rule out other diseases presenting as progressive spastic paraparesis, such as multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS). Though that is not so difficult as the development of imaging technique and neurophysiological tool, if one shows slow progressive spastic paraparesis clinically, and there is no abnormal CSF or EMG findings, it is not easy to differentiate between primary progressive MS and PLS. In fact, PLS is so rare that it has long been debated whether PLS is a disease entity or syndrome or a nothing. But we present a PLS patient whose brain MRI shows diffuse signal change along the bilateral corticospinal tracts and the hypoperfusion of frontal motor cortex is proved by brain SPECT.
Amyotrophic Lateral Sclerosis ; Brain ; Humans ; Magnetic Resonance Imaging* ; Motor Cortex ; Motor Neuron Disease* ; Multiple Sclerosis ; Paraparesis, Spastic ; Pyramidal Tracts ; Tomography, Emission-Computed, Single-Photon

Spinal cord infarction as a complication of spine surgery occurs rarely. Herein, a case of spinal cord infarction, which developed in a 69 year old woman following posterior decompression and internal fixation for a T11 bursting fracture, is descirbed. The anesthetic induction and intraoperative course were uneventful, except at the end of the procedure, where her blood pressure suddenly dropped from 130/90 to 90/60 mmHg. The patient was aggressively treated with a transfusion and vasopressor, the blood pressure then returned to its usual value within 10 minutes. However, during a physical examination in the recovery room, the patient was found to have flaccid lower limbs, with impaired sensory function below the T8 level. Her cord diameter had increased, and a high signal lesion was observed within the thoracic spinal cord, from T9 to T12 level on T2-weighted MR images, which was diagnosing as a spinal cord infarction, was and showed no improvement despite the immediate and aggressive treatment.
Aged ; Blood Pressure ; Decompression ; Female ; Humans ; Infarction* ; Lower Extremity ; Physical Examination ; Recovery Room ; Sensation ; Spinal Cord* ; Spine*

Branch retinal vein occlusion(BRVO), along with central retinal vein occlusion, is second only to diabetic retinopathy as a cause of retinal vascular disease. It has been suggested that eyes with shorter axial length have smaller lamina cribrosa and a narrower scleral canal through which the central retinal vein and artery could pass, causing physical blockage in the vein which predisposes to thrombus formation. The subsequent narrowing of the venous lumen will lead to trubulence. reduced flow, venous stasis and thrombus formation at the level of the arteriovenous crossing. This study was conducted to determine whether there was any difference between the axial lengths of eyes with BRVO and those of control eyes. The axial lengths of the eyes in the group of 37 patients with a unilateral BRVO was compared with those of eyes in the control group. The BRVO group consisted of 23 male and 14 female patients and their mean ages were 61.5+/-7.0 years(51~75years) in male and 63.7+/-7.0 years(52~76years) in female. The control group consisted of 46 male and 28 female patients and their mean ages were 62.5+/-6.5 years(50~73years) in male and 63.9+/-6.1 years(52~75years) in female. The mean axial length of eyes of the BRVO group was 23.08+/-0.57mm(21.92~24.19mm) in male and 22.71+/-0.65mm(21.08~24.00mm) in female. The mean axial length of control eyes was 23.74+/-0.73mm(22.46~25.24mm) in male and 23.18+/-0.81mm(21.62~24.76mm) in female. The difference between the mean axial length of eyes of the BRVO group and that of control eyes was statistically significant(p<0.05). In conclusion, the short axial length may play as a risk factor in the occurrence of a BRVO.
Arteries ; Diabetic Retinopathy ; Female ; Humans ; Male ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Risk Factors* ; Thrombosis ; Vascular Diseases ; Veins

BACKGROUND: An accurate and rapid method for specise identification of coagulase negative staphylococci(CNS) has been increasingly necessary for the clinical significance and planning the management of patients with staphylococcal infections. Recently, it has been reported that there is a highly conserved area on their 60KDa heat shock protein(HSP60) gene sequences between the interspecies of CNS and it can be amplified by a set of universal degenerate primer. This led us our attention to focus on whether the PCR-based RFLP method using Mse / restriction enzyme could be a useful tool for the species identification of CNS. METHODS: In the present study, we performed PCR-based RFLP analysis using a set of degenerate primers covering HSP60 and Mse / restriction enzyme on the reference strains and 25 clinical isolates(10 of S. epidermidis, 10 of S. haemolyticus, 4 of S. lugdunensis and 1 of S. warneri) which were previously identified by the API-STAPH, Vitek GPI card and/or with conventional biochemical test. RESULT: All the seven reference strains revealed that each strain has a distinct electrophoresed band patterns with combination of different number (up to 8) and size of fragments. And these distinct band patterns showed remarkable concordance with the seven reference strains and 25 clinical isolates. CONCLUSION: These result strongly suggest that the PCR-RFLP method using degenerate primers covering the HSP60 gene and Mse / digestion enzyme offer a convenient and accurate tool for species-specific identification of CNS.
Chaperonin 60* ; Coagulase* ; Digestion ; Heat-Shock Proteins* ; Hot Temperature* ; Humans ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Shock ; Staphylococcal Infections

OBJECTIVE: Peripartum emergency cesarean hysterectomy of 28 cases at our hospital for 10years were reviewed that the clinical indication, history, and annual incidence change. METHODS: A retrospective descriptive analysis from January, 1988 to December, 1997 was carried out. RESULTS: There were 28 cases of emergency cesarean hysterectomy identified during this period among total 24, 689 deliveries. The annual incidence of emergency cesarean hysterectomy was significantly declined statistically(p<0.005). Cesarean hysterectomy was performed in 20 of 6, 671 cesarean section(0.30%) and in 8 of 18, 018 vaginal deliveries(0.04%), so more frequently after cesarean section than vaginal delivery. The cesarean hysterectomy rate was more frequent in multiparous women(0, 22%) than in nulliparous women(0, 02%). The most common indication of cesarean hysterectomy was 13 cases of uterine atony(46%), followed by 5 cases uterine rupture(18%), 5 cases of placenta previa with placenta accreta(18%), 3 cases of placenta previa(11%), 2 cases of uterine myoma(7%). No significant difference in length of operating time, amount of blood loss and operative complications were found between total abdominal hysterectomy and subtotal hysterectomy. The all patient who had cesarean hysterectomy recieved from 1200ml to 15840ml of blood transfusion with a mean of 3673ml. In aspect of fetal outcome, 3 cases of FDIU(Fetal death in utero) in uterine rupture and 1 case of stillbirth in preterm were found. The maternal complications were wound disruption, DIC, wound hematoma, ureter injury, vaginal stump bleeding, UTI(Urinary tract infection) and retroperitoneal bleeding, CONCLUSION: We conclude that the incidence of emergency cesarean hysterectomy declined with prediction of antenatal risk factor, preparing of sufficient fresh blood, prophylactic antibiotics, vigorous uterotonics and close observation after delivery.
Anti-Bacterial Agents ; Blood Transfusion ; Cesarean Section ; Dacarbazine ; Emergencies* ; Female ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy* ; Incidence ; Peripartum Period* ; Placenta ; Placenta Previa ; Pregnancy ; Retrospective Studies ; Risk Factors ; Stillbirth ; Ureter ; Uterine Rupture ; Wounds and Injuries

No abstract available.
Lung Neoplasms* ; Lung*

Clear cell sarcoma is a rare malignant rumor of the kidney which occurs in children and is differentiated from Wilms' tumor by its different clinicopathologic features and natural history. Previous studies indicate that this tumor may be of mesenchymal cell origin; however, this has not been proven conclusively. Further accumulation and study need to be conducted in order to clarify the histogenesis of this tumor. We report two cases of clear cell sarcoma of the kidney which occurred in a 2 and a half-year old and a 2-year old boy. This report places special emphasis on the clinicopathologic characteristics of these two cases including electron microscopic and immunohistochemical findings. Attempts were also made to differentiate the clinicopathologic aspects of clear cell sarcoma from Wilms' tumor and speculate on the histogenesis of this rumor.
Child ; Male ; Female ; Humans