Wernicke's encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke's encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke's encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.
Acute Kidney Injury ; Adult ; Alcohol Drinking ; Ataxia ; Female ; Humans ; Hyperemesis Gravidarum* ; Neurologic Manifestations ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Shock ; Thiamine ; Thiamine Deficiency ; Uterine Hemorrhage ; Wernicke Encephalopathy*

The purpose of this study was to investigate learners' opinion about the experience of online continuing medical education, and the effectiveness of it. The study was conducted on online continuing medical education courses conducted as a model case by Konggi-do Medical Association and VirtualMD Co., Ltd with the approval of Korean Medical Association, from July through December, 2002. Fifteen online multimedia courses, supported by learning management system and e-test(electronic assessment) system, were opened. Learners' internet log data, and answers to a questionnaire were collected. And a pre-test post-test design experiment was implemented to measure the effectiveness of learning. The results showed that doctors are already technically and environmentally ready to take online continuing medical education and have correct understanding about the necessity and benefits of online continuing medical education. The difference between the pre-test score and the post-test score was statistically significant(t=3.24, p<.01), and practically significant(Effect Size=.89).
Education, Medical, Continuing* ; Internet ; Learning ; Multimedia ; Surveys and Questionnaires

Gallbladder (GB) cancer is asymptomatic in nature, making diagnosis and treatment difficult. The lymph node status is the strongest predictor of long-term survival for patients with GB cancer, and a complete removal of regional lymph nodes is important for patients undergoing radical resection of GB cancer. Unfortunately, lymph node metastases are common in the early stages of GB cancer. However, there have only been a few cases describing the symptoms or complications of metastatic lymph nodes in patients with GB cancer. Although hemoperitoneum caused by metastatic lymph nodes can occur with several cancers, it is very rare. To the best of our knowledge, hemoperitoneum from spontaneous ruptures of metastatic lymph nodes with GB cancer has not yet been reported. Herein, we describe such a case in a patient newly diagnosed with GB cancer.
Diagnosis ; Gallbladder Neoplasms* ; Gallbladder* ; Hemoperitoneum* ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Rupture ; Rupture, Spontaneous*

No abstract available.
Granuloma* ; Syphilis, Cutaneous*

The authors report a case of fusiform aneurysm in the proximal anterior cerebral artery(ACA). A 44-year-old woman presented with severe headache after subarachnoid hemorrhage. The right carotid angiography demonstrated a fusiform aneurysm in the A1 segment of right ACA with vasospasm. Clipping of a fusiform right A1 aneurysm was performed via the right pterional approach. The postoperative cerebral angiography demonstrated complete occlusion of the fusiform aneurysm and moderate degree of vasospasm with preservation of A1 segment. The postoperative course was uneventful. We report a case of fusiform aneurysm of A1 segment that was successfully clipped with the fenestrated aneurysmal clip.
Adult ; Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Cerebral Angiography ; Female ; Headache ; Humans ; Subarachnoid Hemorrhage

BACKGROUNDS/AIMS: The occurrence of acute hepatitis A is increasing and its progression to fulminant hepatic failure (FHF) is frequent. We investigated the frequency and clinical outcomes of fulminant hepatitis A and also analyzed the predictive factors of spontaneous survival. METHODS: A total of 568 patients presented with acute hepatitis A from January 2003 to June 2008, of which the 35 (6.2%) patients with FHF were divided into two groups: spontaneous survival and transplant/death. These two groups were compared according to various clinical features including the MELD score and King's College Hospital (KCH) criteria. RESULTS: The rate of FHF development increased over time among patients with acute hepatitis A: 0% in 2003, 3.4% in 2004, 3.2% in 2005, 6.0% in 2006, 7.7% in 2007, and 13.0% in 2008. Twenty patients (57.1%) showed spontaneous survival, 13 (37.1%) received liver transplantation, and 5 (14.3%) died during hospitalization. The two groups of spontaneous survival (N=20) and transplant/death (N=15) showed significant differences in prothrombin time at admission and at its worst value, albumin at its worst value, and hepatic encephalopathy grade at admission and at its worst value. The MELD score was lower in the spontaneous-survival group than in the transplant/death group (27.0+/-7.8 vs. 37.0+/-7.1, mean+/-SD; P=0.001). However, KCH criteria did not differ significantly between the two groups. On multivariate analysis, HEP grade was the only significant predictive factor, being negatively correlated with spontaneous survival (OR=0.068, P=0.025). CONCLUSIONS: FHF due to hepatitis A has increased in recent years, and in our cohort the HEP grade was closely associated with spontaneous survival.
Acute Disease ; Adult ; Female ; Hepatitis A/*complications/diagnosis ; Humans ; Liver Failure, Acute/*diagnosis/etiology/*mortality ; Liver Transplantation ; Male ; Multivariate Analysis ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome

Analgesics ; Blood Pressure ; Conscious Sedation ; Dentistry ; Fentanyl ; Heart ; Heart Rate ; Humans ; Ketorolac ; Memory ; Midazolam ; Surveys and Questionnaires ; Reference Values ; Surgery, Oral ; Vital Signs

TrkA is essential components of the high-affinity NGF receptor necessary to mediate biological effects of the neurotrophins NGF. Here we report on the expression of trkA in the cerebral cortex and diencephalon of mongolian gerbils during postnatal development. The expression of trkA was identified by immunohistochemical method. In parietal cortex and piriform cortex, higher levels of trkA-IR (immunoreactivity) were detected at 3 days postnatal (P3) and at P9. Although trkA was not expressed till P3 in the parietal cortex, it was detectable at birth in the piriform cortex. Several regions, such as Layers I, IV & VI, did not show much expression. Layer I showed especially weak labeling. In the hippocampus, thalamus, and hypothalamus, higher levels of trkA-IR were detected at P6 and P12 than earlier days. But trkA was not expressed at birth in the hippocampus, at P3 in the reticular thalamic nucleus (Rt), or neonatally in the dorsomedial hypothalamic nucleus (DM). This data shows that expression of trkA is developmentally regulated and suggests that high affinity neurotrophin-receptors mediate a transient response to neurotrophines in the cerebral cortex and diencephalon during mongolian gerbil brain ontogeny.
Animals ; Animals, Newborn ; Cerebral Cortex/*metabolism ; Diencephalon/*metabolism ; Gerbillinae/*metabolism ; Immunohistochemistry/veterinary ; Nerve Growth Factor/metabolism ; Receptor, trkA/*metabolism

Animals ; Durapatite ; Fibroins ; Microcomputers ; Osteogenesis ; Parietal Bone ; Rabbits ; Silk ; Skull ; Transplants ; X-Ray Microtomography

Aged ; Carcinoma ; Carcinoma, Squamous Cell ; Gingiva ; Head ; Humans ; Lymph Nodes ; Male ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy