No abstract available.
Aspergillosis*

BACKGROUND: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. MATERIAL AND METHOD: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating. RESULT: There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59degrees C without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively (p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%). CONCLUSION: Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.
Autonomic Nerve Block ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Interviews as Topic ; Neurons ; Postoperative Complications ; Surveys and Questionnaires ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

BACKGROUND: Normal saline is used to dilate the epidural space to provide a focal length for the lens and to wash the epidural adhesive neural tissue in an epiduroscopy. Saline infusion into the epidural space during an epiduroscopy might affect pressure-volume compliance of the CSF which has a high compliance; therefore, it might cause neurological sequelaes. The purpose of this study was to investigate the change of cervical epidural pressure according to the volume of infused saline during epiduroscopy. METHODS: Twenty-one patients who complained of low back pain with radiculopathy that did not respond to conservative pain management and underwent an epiduroscopy were included in this study. The epidural catheter was placed between the 5th and 6th cervical epidural space under fluoroscopic guidance and cervical epidural pressure was monitored. Next, an epiduroscopy via caudal route was performed and cervical epidural pressure was measured after each 10 ml of infused saline. We also checked neurological sequelaes that might be resulted from increased epidural pressure. RESULTS: All patients except two showed no difference in basal cervical epidural pressure. One patient who had failed back surgery syndrome complained of a headache and dizziness when the cervical epidural pressure was rapidly increased from 90 mmHg to 5 mmHg following an infusion of 27 ml of saline. One patient who had a herniated disc showed posterior nuchal pain and stiffness following an infusion of 48 ml of saline despite a stable cervical epidural pressure (range: 0 - 3 mmHg) during the procedure. There were no residual neurological sequelaes in this study. CONCLUSIONS: There are variable patterns in cervical epidural pressure according to the volume of infused saline. Close monitoring of intracranial pressure is therefore neccessary during an epiduroscopy.
Adhesives ; Catheters ; Compliance ; Dizziness ; Epidural Space ; Failed Back Surgery Syndrome ; Headache ; Humans ; Intervertebral Disc Displacement ; Intracranial Pressure ; Low Back Pain ; Pain Management ; Radiculopathy

Ehlers-Danlos syndrome represents a group of inherited connective tissue disorders characterized by varying degrees of joint laxity, skin fragility and hyperextensibility, and a bleeding tendency. The essential defect is a quantitative deficiency of collagen. At present, 10 clinical forms have been recognized on the basis of extent and severity of the principal features, in combination with other abnormalities and the likely mode of inheritance. Type II Ehlers-Danlos syndrome is characterized by mild skin and joint manifestations, the latter limited to hands and feet, and inherited as an autosomal dominant pattern. We experienced a case of type II Ehlers-Danlos syndrome in 9-year-old girl with easy bruisability, skin hyperelasticity, thin, atrophic and a shiny scar, the so-called cigarette-paper scar on anterior side of lower extremities, and joint hypermobility limited to hand and feet. The diagnosis was made by characteristic clinical features and skin biopsy findings. A brief review of related literature was made.
Biopsy ; Child ; Cicatrix ; Collagen ; Connective Tissue ; Diagnosis ; Ehlers-Danlos Syndrome* ; Female ; Foot ; Hand ; Hemorrhage ; Humans ; Joint Instability ; Joints ; Lower Extremity ; Skin ; Wills

We reviewed 27 patients wlth cerebellar infarction which was demonstrated by brain CT and/or MRI. Infarction occurred in the territory of posterior inferior cerebellar artery (PICAj in 16 patients, and the territory of the superior cerebellar artery(SCA) was involved in 5 patients. Antenor inferior cerebellar artery(AICA) infarcts occurred in 3 patients. Both PICA and SCA temtories were involved in 2 patients. In the remaining 1 patient, the infarct encompassed the borderzone between the SCA and PICA territories. The main symptoms and signs were sudden onset of vertigo, dizziness, nausea, vomiting, dysmetria, ataxia, nystagmus, and headache. There were signs of associated brain stem infarction or occipitotemporal infarction; rostral basilar artery syndrome, classic SCA syndrome, Wallenberg syndrome, internuclear ophthalmoplegia, facial palsy, hearing impairment. Presumed cerebral embolism was the main stroke mechanism in the SCA terntories. Six patients with brainstem compression or brainstem involvement showed consciousness deterioration, and only one of them died as a result of extensive cerebellar infarctions involving both SCA and PICA territories Cerebellar infarction may run a more benign course than previously thought.
Arteries ; Ataxia ; Basilar Artery ; Brain ; Brain Stem ; Brain Stem Infarctions ; Cerebellar Ataxia ; Consciousness ; Dizziness ; Facial Paralysis ; Headache ; Hearing Loss ; Humans ; Infarction* ; Intracranial Embolism ; Lateral Medullary Syndrome ; Magnetic Resonance Imaging ; Nausea ; Ocular Motility Disorders ; Pica ; Stroke ; Vertigo ; Vomiting

PURPOSE: Recent guidelines for sepsis treatment emphasizes the need for early recognition of disease, leading to the development of the MEDS scoring system. However, there has been no prospective validation or comparison against other scoring systems. Therefore, we prospectively validated the MEDS scoring system and compared it withMultiple Organ Dysfunction Score (MODS) and Sepsisrelated Organ Failure Assessment (SOFA) scoring systems. METHODS: MEDS, MODS, and SOFA scores of 288 patients who were suspected to have systemic infection were calculated at the times of their emergency department visits, and clinical data of the patients were reviewed after six months. Results: MEDS, MODS, and SOFA scoring systems were all valid in the prediction of mortality according to logistic regression analysis. The results of probit analysis revealed significant and direct relationships between the scores and the mortality rate and demonstrated the parallelism of the mortality prediction of the three scoring systems. The cut-off values for the MEDS scoring system successfully divided subjects into five groups according to their risk for death. And the MEDS score well predicted the admission to ward or intensive care unit in survived patients. CONCLUSION: MEDS, MODS, and SOFA scor all were good predictors of outcome for patients with suspected sepsis and showed the same degree of predictive power. The MEDS scoring system, however, featured ease of calculation and definite clinical cut-off values which were useful in guiding decisions about treatment options. It also was well correlated with the prognosis of survived patients. We believe it to be the most useful and appropriate clinical prediction tool in cases of suspected sepsis in the emergency department.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Logistic Models ; Mortality* ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Prospective Studies ; Research Design ; Sepsis*

No abstract available.
Fistula* ; Stomach* ; Tuberculosis*

Allografts ; Diplopia ; Enophthalmos ; Orbit ; Orbital Fractures ; Polyethylene ; Transplants

Background: The purpose of this study was to explore the relationship between the local extinction index and total medical service utilization. Methods: A fixed effects model in panel analysis was performed for the 228 administrative districts in Korea. The statistical yearbook on the usage of medical services by region and Korean Statistical Information Service data were used from 2010 to 2019 for analysis.Medical service utilization was represented by the number of visits day, the number of inpatient days, and medical charges. Control variables were selected by using an Anderson model. The local extinction index was calculated using resident registration population data. Results: Descriptive statistics showed that the number of areas at risk of extinction increased from 61 to 95 for the study years. In addition, the number of visits, the number of inpatient days, and medical charges all increased during the study years. After controlling for variables affecting medical service utilization and doing a panel fixed effects model, the result suggested that a one-step increase in the local extinction index was significantly associated with a 12.29% decrease in medical charges of inpatients, a 7.33% decrease in medical charge of outpatient, a 5.21% decrease in the number of inpatient day, and a 5.54% decrease in the number of visits day. Conclusion This study showed that the higher the region’s extinction risks, the higher the region’s total medical service utilization.The results of this study suggested that there was a disparity in medical service utilization between areas at risk of extinction and areas not at risk of extinction, so measures should be taken to address this disparity.

BACKGROUND: The objectives of our study were to assess the effects of oxidative stress on the proliferation, differentiation and apoptosis of human bone marrow stromal cell (BMSC)-derived osteoblasts and to explore pathways by which osteoblast cell apoptosis was induced. METHODS: Mononuclear cells including BMSCs were cultured to osteoblastic lineage. Different doses of hydrogen peroxide (H2O2) were added to the culture media. The colony forming units-fibroblastic (CFU-Fs) were stained with crystal violet and alkaline phosphatase (ALP). The MTT assay was done to see the effect of H2O2 on cell viability. The effect of H2O2 on osteocalcin gene expression was determined by RT-PCR. The matrix calcification measurement was performed. FACS analysis was performed to determine the osteoblasts apoptosis. Caspase-3, -8 and 9 activity assay and cytochrome c release were measured. RESULTS: The size and number of ALP (+) CFU-Fs were also decreased by H2O2 treatment. When compared with the control group, H2O2 significantly decreased the total number of cells of each culture well during MTT assay. H2O2 significantly diminished expression of osteocalcin mRNA. N-acetylcystein (NAC) blocked the diminution of cell viability and the inhibition of osteocalcin mRNA expression by H2O2. H2O2 reduced matrix calcification. FACS analysis revealed H2O2 increased percentage of apoptotic cells. Addition of H2O2 resulted in the increase of caspase-9 and -3 activity but not caspase-8, and release of cytochrome c to the cytosol. CONCLUSION: These data suggest that, in primary human BMSCs, oxidative stress inhibits proliferation of stromal cells and inhibits the differentiation to osteoblastic lineage. In addition, oxidative stress induces apoptosis of human BMSC-derived osteoblasts and this may be mediated by mitochondrial pathway of apoptotic signal.
Alkaline Phosphatase ; Apoptosis ; Bone Marrow* ; Caspase 3 ; Caspase 8 ; Caspase 9 ; Cell Survival ; Culture Media ; Cytochromes c ; Cytosol ; Gene Expression ; Gentian Violet ; Humans* ; Hydrogen Peroxide ; Mesenchymal Stromal Cells ; Osteoblasts* ; Osteocalcin ; Oxidative Stress* ; RNA, Messenger ; Stromal Cells