We report a 33-year-old man with AIDS dementia complex, which is one of the most common neurologic complica-tion of HIV-1 infection. The man presented with mild psychomotor slowing and episodic loss of consciousness about 5 years after the detection of the HIV-1 infection. His symptoms included forgetfulness, concentration difficulties, apathy, and psychomotor retardation which progressed rapidly evolving into the characteristic features of terminal HIV-1-asso-ciated dementia complex, such as severe dementia, mutism, incontinence, and paraparesis before death. Brain MRIrevealed diffuse confluent high signal intensity lesions in the subcortical white matter on the T2 weighted image. HIV encephalitis (AIDS dementia complex) was confirmed by a brain autopsy.
Acquired Immunodeficiency Syndrome ; Adult ; AIDS Dementia Complex* ; Apathy ; Autopsy* ; Brain ; Dementia ; Encephalitis ; HIV ; HIV-1 ; Humans ; Mutism ; Paraparesis ; Unconsciousness

Deliberate hypotension reduces bleeding into a wound, thereby providing the surgeon with both better visilibility and technical freedom for a more definitive dissection and minimizes the need for blood transfusion, thereby reducing the risks of transfusion reasctions, hepatitis and acquired immunodeficiency syndrome (AIDS). In this study we evaluated the hypotensive anesthesia induced by sodium nitroprusside for maxillofacial reconstruction and plastic surgery performed at Seoul Paik Hospital from March 19S8 to February 1989: The results of our study were as follows: 1) Halothane and enflurane were used as the main anesthetics in 77 and 6 cases respectively. Nitroprusside was used for inducing hypotension and the mean amount infused was 10.5+/-7.7 mg. 2) The mean arterial pressure at 30min after inducing hypotension was 64.5+/-5.3mmHg. 3) The mean blood loss was 736.9+/-394.5ml and the mean amount of transfused blood was 497.1+/-451.1 ml. 4) The intraoperative arterial blood gas analysis shoueds no significant abnormality. 5) There were no significant perioperative and postoperative complications due to induced hypotension itself. In conclusion, the technique of using induced hypotension with inhalation anesthesia supplemented by nitroprusside under 10 head up position is relatively safe and useful one to use in performing maxillofacial reconstruction and plastic sugery.
Acquired Immunodeficiency Syndrome ; Anesthesia* ; Anesthesia, Inhalation ; Anesthetics ; Arterial Pressure ; Blood Gas Analysis ; Blood Transfusion ; Enflurane ; Freedom ; Halothane ; Head ; Hemorrhage ; Hepatitis ; Hypotension ; Nitroprusside ; Postoperative Complications ; Seoul ; Surgery, Plastic ; Wounds and Injuries

No abstract available.
Smoking* ; Tobacco Products*

PURPOSE: Mucinous carcinoma of breast was known to have a lower lymph node metastasis and better prognosis than other type of breast cancer. This study was performed to clarify the clinicopathologic features and prognosis of mucinous breast carcinoma. MATERIALS AND METHODS: We reviewed clinicopathologic features of 40 patients diagnosed mucinous breast carcinoma from Jan. 1985 to Dec. 1995 and compared 31 patients of unmixed mucinous breast carcinoma with 1128 patients of infiltrating ductal carcinoma group. RESULTS: Of total 40 mucinous ca., 31 cases were unmixed type showing no component of invasive ductal component(IDC) and 9 cases were mixed type showing IDC. The average age of the patients was 47 ranging from 31 to 71 years. The most common symptom was palpable breast mass(38 cases, 95%). According to TNM classification, the numbers of unmixed type were following, stage I 14 cases(45%), stage II 15 cases(48%), and stage III 2 cases(7%), and of mixed type, stage I 1 cases(11%), and stage II was 8 cases(89%). Axillary lymph node metastasis was shown to be negative in 26 cases of unmixed mucinous carcinoma(84%), whereas it did in 544 cases of infilterating ductal carcinoma(48%)(p<0.05). Because all patients with unmixed mucinous carcinoma survived except 2 patients who died of cancer unrelated causes, it was impossible to analyze the difference of outcome in unmixed mucinous carcinoma and infilterating ductal carcinoma(5YSR: 81%). CONCLUSION: Considering unmixed mucinous carcinoma had fewer axillary lymph node metatasis than infiterating ductal carcinoma, it may be concluded that unmixed mucinous carcinoma had better prognosis.
Adenocarcinoma, Mucinous ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Classification ; Humans ; Lymph Nodes ; Mucins* ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Vancomcyin-resistantenterococci (VRE) have been an important nosocomial pathogen in the 1990s. Recently, VRE have become an emerging nosocomial pathogen in Korea, but there have been no nationwide study about the status of VRE in Korea. This nationwide questionnaire survey was aimed to determine the prevalence of VRE, the appropriateness of detection method for VRE, and to evaluate the infection control program in hospitals of various size in Korea. METHODS: During 4 weeks (September 1 to October 1, 1999), a questionnaire surveillance study was conducted. We had sent the questionnaire to 200 large hospitals in Korea, which were distributed nationwide. Questionnaire included the prevalence of VRE within the hospital, the detection method for VRE, method of enterococci isolation, antibiotics-susceptibility test and infection control method of VRE. RESULTS: The response rate to questionnaire was 42%. The species identification of enterococci was capable in 62.3% but the accurate enterococcal speciation were capable in 18%. Appropriate antibiotic-susceptibility test were produced only in 6.5%. Total 746 VRE were detected in 42 hospitals during 1-year despite of low sensitivity of detection methods. VRE was noted in 54.4% of hospitals at least. The isolation programme of VRE infected patients was presented in 20.3%, regular surveillance of VRE in high-risk population was produced only in 16.5%. CONCLUSOIN: The prevalence of enterococci among microorganisms isolated from clinical specimens were increased up to 27.7% in Korea. VRE has been emerged in many big cities as well as in Seoul. The microbiological methods that include the speciation of enterococcal isolates, antimicrobial susceptibility test, and VRE detection appeared to be inappropriate in many hospitals. And, proper control and prevention methods were presented in a few hospitals. Education and training about accurate detection of VRE as well as proper infection control programs for VRE are urgently needed.
Education ; Humans ; Infection Control* ; Korea ; Prevalence* ; Seoul ; Surveys and Questionnaires

A 46-year-old woman was admitted with an ulcerative lesion on the posterior neck. Four months before admission, the patient took part in a faith healing ritual, which the pastor performed with his fingernails causing wounds. This abnormal method of healing caused repeated injury to the patient in the posterior neck area. Treatment with cefazolin was begun, but the lesion did not improve. Biopsy of the skin lesion and cervical lymph nodes was performed. Microscopical examination revealed findings highly suggestive of syphilis. Serological tests for syphilis were positive and a computed tomographic (CT) scan of the neck showed enlargement of regional lymph nodes and tonsils. A single dose of penicillin G 2.4 million units was given intramuscularly. Two weeks later, the wound had healed. Eight weeks after treatment, the Venereal Disease Research Laboratory titer had decreased and a CT scan of the neck showed a decrease in the size of the lymph nodes. We reasoned that syphilis was non-sexually transmitted, and that the healing ritual was the cause. Our case suggests that skin trauma by scratching with the fingernails may cause an accidental direct inoculation of Treponema pallidum, resulting in extragenital primary syphilis.
Biopsy ; Cefazolin ; Faith Healing ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Nails* ; Neck ; Palatine Tonsil ; Penicillin G ; Serologic Tests ; Sexually Transmitted Diseases ; Skin ; Syphilis* ; Tomography, X-Ray Computed ; Treponema pallidum ; Ulcer ; Wounds and Injuries

PURPOSE: Citron seed oil (CSO) has been reported to have high antioxidant activity. However, the composition and other biologically activities of CSO have not been reported. In this study, we confirmed the fatty acid composition of CSO, which may be beneficial to vascular disease and obesity. METHODS: We investigated the oil composition of CSO using gas chromatography coupled with mass spectrometry (GC-MS) analysis, and cytotoxicity was confirmed by Cell Counting Kit-8 (CCK-8) assay. Nitric oxide (NO) production in human umbilical vein endothelial cells (HUVECs) was measured using Griess reagent, and lipid accumulation and leptin secretion in 3T3-L1 cells were measured by Oil-Red O staining and commercial ELISA kit, respectively. RESULTS: GC-MS analysis indicated that CSO contains several components, including linoleic acid, oleic acid, palmitic acid, stearic acid, linolenic acid, palmitoleic acid, and arachidic acid. In physiological activity analysis, CSO did not induce cytotoxic effects in HUVECs and 3T3-L1 cells. Further, CSO significantly induced nitric oxide and leptin secretion as well as inhibited lipid accumulation. CONCLUSION: CSO increased NO release, inhibited lipid accumulation, and induced leptin secretion, suggesting it may be useful for the management of vessels and weight gain. Although further studies are required to investigate the safety and mechanism of action of CSO, our results show that the composition and physiological activity of CSO are sufficient for its use as functional edible oil.
3T3-L1 Cells ; alpha-Linolenic Acid ; Cell Count ; Chromatography, Gas ; Enzyme-Linked Immunosorbent Assay ; Human Umbilical Vein Endothelial Cells ; Leptin* ; Linoleic Acid ; Mass Spectrometry ; Nitric Oxide* ; Obesity

PURPOSE: Poncirus trifoliata has been reported to have anti-inflammatory, antioxidant, and immune activities. However, its anti-obesity activity and the mechanism by which the water extract of dried, immature fruit of Poncirus trifoliata (PF-W) acts are not clear. This study suggests a potential mechanism associated with the anti-obesity activity of PF-W. METHODS: We measured the effect of PF-W on lipoprotein lipase (LPL) regulation using enzyme-linked immunosorbent assay (ELISA) and an activity assay. The LPL regulation mechanism was examined by reverse transcription polymerase chain reaction (RT-PCR) to measure the mRNA expression of biomarkers related to protein transport and by western blot for analysis of the protein expression of the transcription factor CCAAT-enhancer-binding protein (C/EBPbeta) RESULTS: The total polyphenol and flavonoid content of PF-W was 52.15 +/- 4.02 and 6.56 +/- 0.47 mg/g, respectively. PF-W treatment decreased LPL content in media to 58 +/- 5% of that in control adipocyte media, and increased LPL content to 117 +/- 3.5% of that in control adipocytes, but did not affect the mRNA expression of LPL. PF-W also increased the mRNA expression of sortilin-related receptor (SorLA), a receptor that induces endocytosis and intracellular trafficking of LPL, in a concentration- and time-dependent manner. Finally, cell fractionation revealed that PF-W treatment induced the expression of C/EBPbeta, a SorLA transcription factor, in the nuclei of 3T3-L1 adipocytes. CONCLUSION: The LPL secretion and activity assay showed PF-W to be an LPL secretion inhibitor, and these results suggest the potential mechanism of PF-W involving inhibition of LPL secretion through C/EBPbeta-mediated induction of SorLA expression.
Adipocytes ; Biomarkers ; Blotting, Western ; CCAAT-Enhancer-Binding Proteins ; Cell Fractionation ; Endocytosis ; Enzyme-Linked Immunosorbent Assay ; Fruit ; Lipoprotein Lipase* ; Polymerase Chain Reaction ; Poncirus* ; Protein Transport ; Reverse Transcription ; RNA, Messenger ; Transcription Factors ; Water*

BACKGROUND: Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. METHODS: The subjects were 34 patients(M : F = 20 : 14, mean age = 61 l7yre) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group I (decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. RESULTS: Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26% (9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.67(4/14) of group 2 and 44.4%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p> 0.01) In three cases of group 3 whose respiratory indices could be measured until 48 hr ater extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. CONCLUSIONS: Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubatuion may increase in the patients who have increased WOB immediately after extubation.
Airway Obstruction ; Gases ; Humans ; Intubation, Intratracheal ; Physical Examination ; Respiration ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Mechanics ; Thorax ; Vital Signs ; Weaning ; Work of Breathing*

Systemic lupus erythemotosus (SLE) is an autoimmune disorder with dermal, renal, and cardiac manifestations. It frequently has cardiovascular complications such as pericarditis, myocarditis, and valvular heart diseases. Valvular heart diseases in SLE comes mainly in the form of mitral or aortic insufficiencies. Report of aortic stenosis is extremely rare. Surgical treatments of valvular heart disease in SLE are not done frequently because of complications in other organs. Aortic stenosis developed in a 59 year-old woman with SLE, and aortic valve replacement was done successfully.
Aortic Valve ; Aortic Valve Stenosis* ; Endocarditis ; Female ; Heart Valve Diseases ; Humans ; Lupus Erythematosus, Systemic* ; Middle Aged ; Myocarditis ; Pericarditis