Most cerebrovascular diseases (CVA) are manifest by the abrupt onset of a focal neurologic deficit. The deficit may remain fixed or may rapidly improve or progressively worsen. Therefore, the main objective of treatment in cerebrovascular disease is the prevention of stroke. The current treatment of CVA may be divided into three parts : (1) management in the acute phase (restoration of the circulation and arrest of the pathologic process), (2) physical therapy and rehabilitation, and (3) prevention of the further recurrent strokes. When faced with an acute stroke, the clinician must differentiate between infarction and hemorrhage immediately, because the method of emergency treatment depends on the cause. The clinician should try to prevent or reverse acute brain injury with thrombolysis, and to inhibit the progression of cerebral infarction with anticoagulation or antiplatelet agents, and to prevent further neurologic injury with neuroprotection and attending to acute medical issues of airway, blood pressure, and concomitant organ failure. In addition, the clinician should remove or control the risk factors of stroke and must elaborate a proper strategy in order to prevent the secondary stroke.
Blood Pressure ; Brain Injuries ; Cerebral Infarction ; Cerebrovascular Disorders ; Emergency Treatment ; Hemorrhage ; Infarction ; Methods ; Neurologic Manifestations ; Neuroprotection ; Platelet Aggregation Inhibitors ; Rehabilitation ; Risk Factors ; Stroke*

No abstract available.
Rectal Neoplasms*

PURPOSE: To document the radiologic characteristic findings of atypical ductal epithelial hyperplasia, we analyzed film mammographic, ultrasonographic, and MRI findings of our cases. MATERIALS AND METHODS: We analyzed 23 cases of surgically proven ADH, excluding carcinoma in ipsilateral breast. Presence and pattern of neodensity, microcalcification, and architectural distortion were reviewed on mammography. Echo pattern and ductal parenchymal morphology were analyzed on ultrasonography, and enhancement speed and pattern analysis were performed on MRI. RESULTS: On film mammography, ADH showed tendency of neodensity(10 of 23 cases), m icrocalcification(11 of 23 cases), with less parenchymal distortion of surrounding structures(7 of 23 cases). On ultrasonography, ADH was demonstrated as inhomogenous to intermediate echoic nodule(16 of 20 cases) with ragged border(19 of 20 cases), however, its boundary was thin or nearly absent(16 of 20 cases), and showed smooth ductal echography(11 of 20 cases). Gd-DTPA contrast dynamic MR study showed relatively slow and less enhancement in 4 out of 5 cases, with progressive inclination of the speed curve of enhancement in later period of dynamic study. CONCLUSION: Multimodality image approach is needed for better evaluation of ADH, however, excisional biopsy is recommended for confirmative diagnosis and proper treatement.
Biopsy ; Breast* ; Diagnosis ; Gadolinium DTPA ; Hyperplasia* ; Magnetic Resonance Imaging ; Mammography ; Ultrasonography*

A histopathological observation of drug-induced morbilliform eruption and erythema multiforme was made on 32 patients with drug eruption, We found that many histopathologic features of drug-induced morbilliform eruption of basal cell layer with infiltration of derrnoepidermal junction and necrosis of epidermal keratinocyte were similar to those of drug induced erythema multiforme. Therefore, it seems possible to regard the histopathologic features of druginduced morbilliform eruption and erythema multiforrne as a cornmon tissuc reaction with spectral expression.
Drug Eruptions ; Erythema Multiforme* ; Erythema* ; Humans ; Keratinocytes ; Necrosis

The study comprises 127 inpatients with drug eruption, treated at the Department of Dermatology, Seoul National University Hospital, during a 10-year period. The results are summarized as follows: 1. Out of 1,434 dermatologic inpatients, 127(8. 9%) patients were diagnosed as drug eruption. 2. The cutaneous manifestations of drug eruptions in the order of frequency were as follows: exanthematous eruption, urticaria, erythema multiforme, Stevens Johnson syndrome, TEN, exfoliative dermatitis, fixed drug eruption and purpura. 3. Antibiotics and antimicrobials were the most common causative agents followed by antipyretics and analgesics, CNS depressant drugs and herb drugs. 4. The 5 most common drugs causing drug eruptions were ampicillin, acetyl salicylic acid, diphenylhydantoin, sulfonamide and phenacetin.
Ampicillin ; Analgesics ; Anti-Bacterial Agents ; Antipyretics ; Dermatitis, Exfoliative ; Dermatology ; Drug Eruptions* ; Erythema Multiforme ; Humans ; Inpatients ; Phenacetin ; Phenytoin ; Purpura ; Salicylic Acid ; Seoul ; Stevens-Johnson Syndrome ; Urticaria

A 36-year-old female patient with sarcoidosis is presented showing lupus pernio, papular skin lesions, cervical lymph node enlargement and lung lesions. Diagnosis was confirmed by characteristic histologic findings of noncaseating granulomas in skin and cervical lymph node, supported by compatible clinical and laboratory features. Methatrexate was administered orally, which resulted in considerable improvement of skin lesions.
Adult ; Diagnosis ; Female ; Granuloma ; Humans ; Lung ; Lymph Nodes ; Methotrexate ; Sarcoidosis ; Skin

We investigated the distribution of S-100 protein positive dendritic cells in the skin lesions with tuberculoid sturcture. For this study, we selected the paraffin blocks of biopsied specimens with the characteristic histopathology of lupus vulgaris (5cases), tubereulosis verrucosa cutis (1 case), lupus milaris disseminatus faciei (4 cases), and erythema induratum (7 cases). The cells were identified by immunohistochemical demonstration in paraffin sections. The results were as follows: 1. S-100 protein positive dendritic cells were regularly visualized in all lesions examined. 2. S-100 protein positive dendritic cells appeared usually between the lymphohistiocytic infiltrates around the tuberculoid granulomas in contrast to the cells of monocyte-macrophage system which were within the granulomas. And they appeared occasionally (e.g. in a case of lupus vulgaris) between epitheloid cells in the granulomas. 3. S-100 protein positive dendritic cells were more numerous in the granulomatous lesions which showed the well-formed tuberculoid sturcture. From these results, we suggested the S-100 protein positive dendritic cells act as accessory cells in the pathogenesis of the granulomatous lesions by the delayed type hypersensitivity.
Dendritic Cells* ; Erythema Induratum ; Granuloma ; Hypersensitivity ; Lupus Vulgaris ; Paraffin ; S100 Proteins ; Skin*

Immunohistochemical staining was performed in 20 skin granulomas of 16 patients with leprosy using antisera against lysozyme and S-100 protein. In lepromatous leprosy, lysozyme positive cells and S-100 protein positive cells were rarely found in the dermis. However, the histoid leprosy specimen had large numbers of lysozyrne positive cells and S-100 protein positive cells in granuloma. In borderline group, lysozyme positive cells and S-l00 protein positive cells were found in the dermis. S-100 protein positive cells were diffusely distributed throughuut the granuloma in borderline lepromatous leprosy, while they were often found in lymphocytic mantle in borderline tuberculoid leprosy. In tuberculoid leprosy, lysozymal staining was encouritered in epitheloid cells and giant cells, but S-100 protein positive cells were predominantly found encircling granuloma. In the epidermis, great numbers of S-l00 protein positive cells were found in tuberculoid leprosy than in lepromatous leprosy.
Dermis ; Epidermis ; Giant Cells ; Granuloma ; Humans ; Immune Sera ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Leprosy, Tuberculoid ; Muramidase* ; S100 Proteins ; Skin

No abstract available.
Head*

The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance From 1984 to 1994, an average LOS of each hospital was analyzed by factors such as medical departments, bed size, occupancy rate, region and ownership. This study was analyzed changing rate of LOS during 11 years. This rate was calculated by simple regression, which was used only with hospital without missing data during 11 years. This study findings are as follows. 1. The results indicated that the average LOS was steadily increased until 1990 but it was slightly decreased after 1990. 2. This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals, and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. 3. Means of changing rates of LOS were calculated from 1984 to 1994. If we divided it into two parts, before 1990 and after 1990, most changing rates of LOS before 1990 except individual owned hospital were found positive sign. The changing rates after 1990 were negative sign but small hospital(lesser then 200 bed), individual owned hospital, national & public hospital and hospital in small urban have little change of LOS after 1990. Finally from this results we thought that most hospitals in korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this trend may be caused by a few patients, low occupancy rate, or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon is resulted from the reimbursement method. Because of fee for service reimbursement system in korea the hospitals didn't need to shorten LOS in order to save the cost and increase the profit. Therefore reform of hospital cost reimbursement method will be reduced to reduce hospital cost in korea. we thought that the korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the united states. This study presents some limitations such as on insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can possibly affect LOS, However, this study reports an important trend in LOS from 1984 to 1994.
Diagnosis-Related Groups ; Fee-for-Service Plans ; Hospital Bed Capacity ; Hospital Costs ; Hospitals, Public ; Humans ; Internal Medicine ; Korea* ; Length of Stay* ; Ownership ; United States