Holoprosencephaly(HPE), a common developmental defect affecting the forebrain and cranioface, is etiologically heterogenous. Teratogen, chromosomal anomalies, genetic syndrome, or genetic disorder of non-syndromic HPE are usually accepted as etiology. But the severity of brain and craniofacial malformation are not associated with etiology. Individuals with microform of HPE, who usually have normal cognition and brain imaging, are at the risk of having children with HPE. Several studies on the basis of HPE gene have been performed, which shed valuable insight on normal brain development. As additional HPE genes are identified, more accurate recurrent risk counseling can be given. We experienced a case of recurrent HPE diagnosed by transabdominal ultrasound examinations at 22 weeks' gestation.
Brain ; Child ; Cognition ; Counseling ; Holoprosencephaly* ; Humans ; Microfilming ; Neuroimaging ; Pregnancy ; Prosencephalon ; Ultrasonography

No abstract available.
Anesthesia, Local* ; Arthroscopy* ; Knee*

PURPOSE: The 2005 resuscitation guidelines stipulate the need for monitoring CPR (cardiopulmonary resuscitation) quality. Recently, several clinical investigations have shown that a real time monitoring and feedback system is effective for improving the quality of chest compressions during resuscitation. However little data exists regarding the accuracy of the monitoring system using an accelerometer sensor and a pressure sensor for the measuring of compression rate and depth. Our goal for this study was to investigate how well chest compression rate and depth can be estimated using the monitoring system. METHODS: Thirty seconds of continuous chest compressions were delivered on a standard skillmeter manikin lying on the floor with the monitoring system. The chest compressions were delivered with variations in compression rate (67~142 /min) and with variations in compression depth (22~61 mm). A total of 120 sets of compressions were delivered for validation of rate and depth. RESULTS: The correlation coefficient for compression rate between the monitoring system and the standard method was 0.999 (p<0.001), and Bland-Altman analysis showed a mean bias of -0.10+/-0.77/min, with limits of agreement ranging from -1.60 to 1.40 /min. The correlation coefficient for compression depth between two methods was 0.983 (p<0.001), and Bland-Altman analysis showed a mean bias of 4.2+/-2.0 mm, with limits of agreement ranging from 0.24 to 8.10 mm. CONCLUSION: Compared with a skillmeter manikin, a monitoring system for the quality of CPR estimates chest compression rate precisely, but overestimates chest compression depth by an average of 10.3%.
Bias (Epidemiology) ; Cardiopulmonary Resuscitation ; Deception ; Delivery of Health Care ; Floors and Floorcoverings ; Manikins ; Monitoring, Physiologic ; Resuscitation ; Thorax

BACKGROUND: Recently, there has been an increase in acute poisonings in the elderly, which may be associated with attempts at suicide. The purpose of this study was to compare and analyze the clinical aspects and outcomes of acute poisonings in aged individuals with those of younger individuals. METHODS: We performed a retrospective analysis of 207 patients seen in the emergency department (ED) with acute poisoning from January 2009 to December 2010. Two groups were created, >65 years and <65 years. The following were carefully compared-annual frequency, gender distribution, cause of poisoning, poisoning substance, motive for suicide, past psychiatric history, psychiatric interview, psychiatric diagnosis, disposition after ED visit, disposition after admission, poisoning severity score (PSS), duration of hospitalization, intensive care unit (ICU) admission rate, and mortality. RESULTS: The annual frequency was 0.1% in the >65 group and 0.3% in the <65 group, 0.4% in total. The cause of poisoning was accidental more often in those >65 years than in those <65 years. As motive for suicide, health problem was cited more often in the older group (p=0.000). The older group had fewer interviews with psychiatrists and were more often diagnosed with depressive disorder (p=0.010, p=0.041, respectively). PSS and mortality were higher in the older group (p=0.002, p=0.010, respectively). CONCLUSION: A better understanding for the cause of poisonings and the poisonous substance used in the aged population is needed. And because of the more serious effects of acute poisonings to the elderly patient, they should readily receive regular comprehensive care including psychiatric care.
Aged ; Depressive Disorder ; Emergencies ; Hospitalization ; Humans ; Intensive Care Units ; Mental Disorders ; Psychiatry ; Retrospective Studies ; Suicide

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate and compare the factors affecting recovery of spinal cord injury following cervical and thoracolumbar spine injuries. SUMMARY OF LITERATURE REVIEW: Several authors have reported the factors to predict the prognosis of spinal cord injury, but the objective prognostic factors are still controversial. MATERIALS AND METHODS: From June 2006 to March 2013, a total of 44 patients with spinal cord injury were evaluated. Prognostic factors analyzed were sex, age, neurologic status, fracture type, time to operation, use of steroid, and signal change on MRI. We analyzed the relation between each factor and the neurologic recovery. The mean follow-up period was 12 months. The neurologic recovery was analyzed by the ASIA impairment scale at the first and the last neurologic examination. RESULTS: Among 44 patients, 15 sustained complete cord injury while 29 had incomplete cord injury. Significant neurologic recovery using the ASIA impairment scale was evaluated in the incomplete spinal cord injury group. Among this group, the prognosis for Brown-sequard syndrome is better than for central cord syndrome and anterior cord syndrome. There was no significant difference in other factors (fracture site, time to operation, use of steroid or signal change on MRI). CONCLUSIONS: The prognosis in spinal cord injury is determined by the initial neurologic damage and neurologic recovery is not related with the fracture type, time to operation, use of steroid and signal change on MRI.
Asia ; Brown-Sequard Syndrome ; Central Cord Syndrome ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Prognosis ; Retrospective Studies ; Spinal Cord Injuries* ; Spine

Cardiovascular diseases have been the most serious threat to life and health. The socioeconomic ramifications of heart disease have long been a source of vexing legal as well as medical problems with no easy resolution as yet in hand. Heart weight, one of the important factors for the diagnosis of cardiomegaly and various heart diseases, shows extreme variability according to the height, weight, age, sex, nutritional status of individuals as well as other various factors. The purpose of this investigation was to find a practical method for calculating expected normal range of heart weight in a given individual. The study was performed on 259 autopsy cases of normal Korean men and women, consisting of 123 men and 136 women in age from newborn to 77 years old. Height, body weight, and heart weight were measured and the body surface area was calculated by height (cm)0.725 x weight (kg)0.425 x 71.84 and height (cm)0.7763 x weight (kg)0.4081 x 71.84 in men and women, respectively. The results showed that the mean heart weight of men and women older than 20 years old were 316.20 +/- 51.15 g (n=96) and 275.87 +/- 44.69 g (n=108), respectively. Heart weight was gradually increased according to the age. The body weight (men: r=0.81, women: r=0.84) and body surface area (men: r=0.83, women: r=0.83) were better univariate predictors of normal heart weight than body height (men: r=0.78, women: r=0.75) and age (men: r=0.42, women: r=0.57). No significant difference was found in predictive precision between body weight and body surface area. Since the body surface area was calculated from body weight and height, measuring the body weight was essential for calculating expected normal range of heart weight in a given individual, and calculation of expected normal range of heart weight using body weight was simpler method than using body surface area.
Aged ; Autopsy ; Body Height ; Body Surface Area* ; Body Weight* ; Cardiomegaly ; Cardiovascular Diseases ; Diagnosis ; Female ; Hand ; Heart Diseases ; Heart* ; Humans ; Infant, Newborn ; Male ; Nutritional Status ; Reference Values ; Young Adult

Cardiac contusion is an increasingly recognized entity in patients with nonpenetrating chest injury. Unifortunately, the diagnosis of cardiac trauma, particularly cardiac contusion, is imprecise and may be confounded by the presence of associated injuries, hypoxia, shock, and metabolic abnormalities. Symptomatic cardiac injury follwing blunt chest trauma is relatively rare, and valvular injury is even rarer. The valves most commonly affected are mitral and tricuspid. Although tricuspid regurgitations are usually asymptomatic and can resolve spontaneously, recent developments in echocardiography made possible the precise diagnosis of valvular injuries noninvasively, The authors report the case of tricuspid regurgitation incidentally detected by echocardiography in a construction worker who had suffered multiple fractures.
Anoxia ; Contusions ; Diagnosis ; Echocardiography* ; Humans ; Shock ; Thoracic Injuries ; Thorax ; Tricuspid Valve Insufficiency ; Tricuspid Valve*

OBJECTIVE: Unexpected Solitaire stent detachment can occur during mechanical Solitaire thrombectomy. The purpose of this study was to retrospectively evaluate the influencing factors causing unexpected Solitaire stent detachment and the clinical outcomes. METHODS: Between October 2011 to December 2013, 232 cases of mechanical Solitaire thrombectomy for acute ischemic stroke were performed in 3 stroke centers. During this period, we encountered unexpected Solitaire stent detachments during mechanical Solitaire thrombectomies in 9 cases. RESULTS: Solitaire stents unexpectedly detached in 9 cases (3.9%) during the retrieval of Solitaire stents. The median patient age was 76 years. The occlusion sites of the unexpected stent detachment were the proximal middle cerebral artery (MCA) in 7 cases and the internal carotid artery in 2 cases. The sizes of the stents that unexpectedly detached were 6x30 mm in 7 cases, 5x30 mm in 1 case, and 4x20 mm in 1 case. Four patients had unexpected detachment at the first retrieval, 1 patient at the second, 3 patients at the third, and 1 patient at the fifth. In all of the cases of unexpected detachment at the first retrieval, the stent deployment site was the proximal MCA. After detachment, a proximal marker of the Solitaire stent was observed in 3 patients. However, no marker was visible in the remaining 6 patients. CONCLUSION: Unexpected Solitaire stent detachment should be considered in the first instance of stent retrieval for a relatively large-diameter stent, especially in elderly patients with MCA occlusions.
Aged ; Carotid Artery, Internal ; Humans ; Middle Cerebral Artery ; Retrospective Studies ; Stents* ; Stroke ; Thrombectomy*

Coronary neovascularity may be formed in patients with the left atrial thrombus, and coronary artery disease may be associated with valvular heart disease. From August 1989 through September 1990, 109 patients over 40 years old with valvular heart disease were performed coronary arteriogram to evaluate the incidence of the associated coronary artery disease. And 9 patients with left atrial thrombi detected noninvasively were also performed coronary arteriogram to evaluate the significance of the neovascularity to predict the left atrial thrombus. The results were as follows : 1) Significant coronary arterial lesion(greater than 50% narrowing of the luminal diameter) was noted in three of 109 patients over 40 years old(2.8%), but there was no typical chest pain in all of the three patients. 2) The coronary neovascularity was found in 19 of 118 patients -18 with mitral valvular disease and one with combined valvular disease. All of the patients with the coronary neovascularity had established atrial fibrillataion and the neovasculaity was originated from the left circumflex artery in all of them. 3) Prosthetic valve replacement was performed in 42 of 118 patients during the study period and left atrial thrombus was found in ten patients with mitral valve disease. Neovascularity on coronary arteriogram was detected in six patients(sensitivity 60%) of the above 10 patiets, and 28 patients without neovascularity had no left atrial thrombus (28/32, specificity 87.5%). Our observation revealed that neovascularity might represent the left atrial thrombus in valvular heart disease, and the incidence of the associated coronary artery disease in valvular heart disease was very low(2.8%) in Korea. Coronary arteriography as a routine preoperative evaluation might be unnecessary in valvular heart disease in Korea.
Adult ; Angiography ; Arteries ; Chest Pain ; Coronary Artery Disease ; Heart Valve Diseases* ; Humans ; Incidence ; Korea ; Mitral Valve ; Phenobarbital ; Sensitivity and Specificity ; Thrombosis

PURPOSE: To evaluate the differences in MR findings of metastatic adenocarcinoma and non-adenocarcinoma of thebrain. MATERIALS AND METHODS: We retrospectively analyzed MR findigns of metastatic brain tumors in 32 patients;in all cases, pathologic diagnosis was estabilished by biopsy or surgical resection. The signal intensities ofbrain lesions on multiple pulse sequences were compared. The enhancement patterns, degree of peritumoral edema,and number and size of brain lesions were also compared. RESULTS: The study group consisted of 19 patients withmetastatic adenocarcinoma and 13 with metastatic non-adenocarcinoma ; there were 64 adenocarcinomas and 45non-adenocarcinomas. On T1WI, the signal intensity of the lesions was hypointense, isointense, and hyperintense in57.8%, 39.0%, and 3.2% of adenocarcinomas; and 84.5%, 13.3%, and 2.2% of non-adenocarcinomas, respectively. OnT2WI, signals were hyperintense, isointense, hypointense, and heterogeneous in 67.2%, 10.9%, 17.2%, and 4.7% ofadenocarcinomas ; and 80%, 0%, 8.9%, and 11.1% of non-adenocarcinomas, respectively. On T2WI, seven of 19 patientswith adenocarcinoma and two of 13 with non-adenocarcinoma were either hypo- or isointense relative to the whitematter. In the adenocarcinoma group, hypo- or isointensity was seen in four cases of gastrointestinal cancer, twoof lung cancer, and one of endometrial cancer ; in the non-adenocarcinoma group, this was seen in retroperitonealembryonal carcinoma and small cell carcinoma of the lung. Two cases of adenocarcinoma showed hypointensity on T2WIand hyperintensity on TIWI, and this was probably related to the presence of blood products. On histopathology,one case of adenocarcinoma showing hypointensity on T2WI was shown to contain mucin. CONCLUSION: When brainmetastasis shows hypo- or isointensity on T2WI, adenocarcinoma is more likely than non-adenocarcinoma.
Adenocarcinoma* ; Biopsy ; Brain Neoplasms ; Brain* ; Carcinoma, Small Cell ; Diagnosis ; Endometrial Neoplasms ; Female ; Gastrointestinal Neoplasms ; Humans ; Lung ; Lung Neoplasms ; Mucins ; Retrospective Studies