Pick's disease is a rare neurodegenerative disorder presenting cortical type of dementia. Pick's disease shows unique clinical and pathological features, that are due to a degeneration of fronto-temporal lobes of the cerebrum. The authors experienced a case of Pick's disease in a 58-year-old male patient who had dementia symptoms for five years. The patient showed compulsive behavior since five years ago. Memory decline started from four years ago and progressed. Brain CT disclosed lobar atrophy of the cerebral gyri in frontal and temporal lobes. He died of septicemia associated with aspiration pneumonia. At autopsy, both cerebral hemispheres showed marked encephalomalacia. The gyral atrophy was moderately severe in prefrontal and anterior temporal lobes. Coronal section disclosed moderate dilatation of the lateral ventricles. Microscopically, there were marked neuronal loss in prefrontal and anterior temporal cortices. Also noted were Pick's cells and Pick's body in occasional pyramidal cells preserved.
Atrophy ; Autopsy* ; Brain ; Cerebrum ; Compulsive Behavior ; Dementia ; Dilatation ; Encephalomalacia ; Humans ; Lateral Ventricles ; Male ; Memory ; Middle Aged ; Neurodegenerative Diseases ; Neurons ; Pick Disease of the Brain* ; Pneumonia, Aspiration ; Pyramidal Cells ; Sepsis ; Temporal Lobe

Abdominal pregnancy that is a life threatening variant of ectopic pregnancy, has been a rare event with high maternal mortality. It is very difficult to diagnose a abdominal pregnancy clinically. We have experienced a case of early abdominal pregnancy diagnosed at emergency laparotomy and this case was presented with a brief review of the literatures.
Emergencies ; Female ; Laparotomy ; Maternal Mortality ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic

Although attachments have been utilized for a retainer of removable prostheses during several decades, there is little information on the force distribution by the attachments. This study was undertaken to evaluate the stress patterns developed by partial dentures employing rigid attachments on the supporting structures. Four types of the mandibular removable partial dentures were designed depending upon the position of the rigid attachment and the existency of lingual bracing. Under 100N of vertical and 25N of lateral loads on the 1st and 2nd lower molar of partial denture, stress distribution patterns and displacement were analysed with three dimensional finite element method by ANSYS version 5.3. 1. The highest stresses were concentrated on the distal alveolar crest of posterior abutment and the second stresses on the apical region of posterior abutment in the models. 2. The greatest displacement were shown on the distal alveolar crest of posterior abutment and the second displacement on the distal alveolar crest of anterior abutment in the models. 3. There was little difference between the models with intraoral attachment and those with extracoronal attachment. 4. There was little difference between the models with and without the lingual bracing.
Braces ; Denture, Partial* ; Denture, Partial, Removable ; Molar ; Prostheses and Implants

Anatomical shape of the mandibular ramus, which includes the area from the rear of the mandibular second molar to the mandibular posterior border and from the mandibular sigmoid notch to the inferior mandibular border, must be carefully considered to perform orthognathic surgery. The locations of the lingula and mandibular foramen in medial side of mandibular ramus are one of the most important factors to decide the location of the horizontal medial osteotomy in sagittal split ramus osteotomy and to select the line of vertical osteotomy in intraoral vertical ramus osteotomy. Sixty-five different Korean human dry mandibles were surveyed. All mandible have permanent dentition including complete eruption of the mandibular second molar. The locations of the lingula and mandibular foramen in medial side of the ramus were identified and following results were obtained. Anterior ramal horizontal distance from lingula was 16.13+/-3.53mm(range:8.6~24.3mm), anterior ramal horizontal distance from mandibular foramen was 23.91+/-4.79mm(range: 14.1~39.7mm), horizontal width of mandibular foramen was 2.79+/-0.95mm(range: 1.5 ~6.1mm), height of lingula was 10.51+/-3.84mm(range: 3.1~22.4mm), vertical distance from sigmoid notch to lingula was 19.82+/-5.11mm(range: 9.1~35.3mm). From this study, the result could be used to select the location of osteotomy lines and to decide amount of periosteal elevation to avoid injury of neurovascular bundle, and to accomplish the appropriate split in Korean patients in mandibular orthognathic surgery.
Colon, Sigmoid ; Dentition, Permanent ; Humans ; Mandible ; Molar ; Orthognathic Surgery* ; Osteotomy ; Osteotomy, Sagittal Split Ramus

Malignant hyperthermia is a subclinical myopathy, usually triggered by anesthetics and associated with a mortality rate of up to 70%, when left untreated. But with early diagnosis using capnography and with the advent of dantrolene, the mortality rate could be reduced to less than 5%, which implies the significance of early diagnosis and proper treatment. Owing to the reduced mortality rate, anesthesiologists get more chances to encounter patients with a previous history of malignant hyperthermia and knowledge to provide proper anesthetic management become essential. We present a case in which malignant hyperthermia was detected in a 67 year old female patient with gastric cancer and a thyroid mass during the first operation and successfully treated with promptly initiated supportive measures based on capnography finding without dantrolene which was not available at the time and the same patient rescheduled for subsequent gastrectomy in which we chose non-triggering agents in adjunct to epidural anesthesia without provoking malignant hyperthermia.
Aged ; Anesthesia, Epidural ; Anesthesia, General* ; Anesthetics ; Capnography ; Dantrolene ; Early Diagnosis ; Female ; Gastrectomy ; Humans ; Malignant Hyperthermia* ; Mortality ; Muscular Diseases ; Stomach Neoplasms ; Thyroid Gland

PURPOSE: The aim of this prospective, randomized study was to evaluate the effects and adverse effects of nebulized L-epinephrine compared with nebulized budesonide in children with moderate to severe croup. METHODS: Children were eligible for the study if their croup scores fell in the moderate to severe range(scores>4) in the AMC from May 1995 till May 1996. The patients were randomly assigned to receive either 5ml(1 : 1000) of L-epinephrine aerosols(n=9) or 500microgram of budesonide aerosols (n=8). Croup score, O2 saturation by pulse oximeter, heart rate, and blood pressure were recorded before treatment and at 5, 15, 30, 60, 120 minutes after aerosol treatment. Nine patients were enrolled in the nebulized L-epinephrine group and 8 in the nebulized budesonide group, respectively. There were no statistical differences in age, sex and croup score before treatment between the two groups. RESULTS: Total croup score significantly decreased at 15 minutes after treatment in the L-epinephrine group(P<0.05) but at 120 minutes after treatment in the budesonide group(P<0.05). Treatment failed in 1(1/9) patient in the L-epinephrine group and 2(2/8) patients in the budesonide group, who received intramuscular dexamethasone injections. The rebound phenomenon at 120 minutes after treatment was found in 1 patient from both groups. There were no significant changes of heart rate and blood pressure before and after treatment in both groups. CONCLUSION: The treatment using nebulized L-epinephrine showed a more prompt clinical improvement than the treatment using nebulized budesonide and without any significant adverse effects. So it can be recommended for emergent management in children with moderate to severe croup.
Aerosols* ; Blood Pressure ; Budesonide* ; Child ; Croup* ; Dexamethasone ; Heart Rate ; Humans ; Prospective Studies*

PURPOSE: The aim of this prospective, randomized study was to evaluate the effects and adverse effects of nebulized L-epinephrine compared with nebulized budesonide in children with moderate to severe croup. METHODS: Children were eligible for the study if their croup scores fell in the moderate to severe range(scores>4) in the AMC from May 1995 till May 1996. The patients were randomly assigned to receive either 5ml(1 : 1000) of L-epinephrine aerosols(n=9) or 500microgram of budesonide aerosols (n=8). Croup score, O2 saturation by pulse oximeter, heart rate, and blood pressure were recorded before treatment and at 5, 15, 30, 60, 120 minutes after aerosol treatment. Nine patients were enrolled in the nebulized L-epinephrine group and 8 in the nebulized budesonide group, respectively. There were no statistical differences in age, sex and croup score before treatment between the two groups. RESULTS: Total croup score significantly decreased at 15 minutes after treatment in the L-epinephrine group(P<0.05) but at 120 minutes after treatment in the budesonide group(P<0.05). Treatment failed in 1(1/9) patient in the L-epinephrine group and 2(2/8) patients in the budesonide group, who received intramuscular dexamethasone injections. The rebound phenomenon at 120 minutes after treatment was found in 1 patient from both groups. There were no significant changes of heart rate and blood pressure before and after treatment in both groups. CONCLUSION: The treatment using nebulized L-epinephrine showed a more prompt clinical improvement than the treatment using nebulized budesonide and without any significant adverse effects. So it can be recommended for emergent management in children with moderate to severe croup.
Aerosols* ; Blood Pressure ; Budesonide* ; Child ; Croup* ; Dexamethasone ; Heart Rate ; Humans ; Prospective Studies*

A 71-year-old man who had no prior history of chemotherapy or radiation therapy was diagnosed with nodular sclerosis Hodgkin's disease (HD) and IgA-kappa multiple myeloma (MM) simultaneously. The patient achieved a complete response of HD and a minor response of MM after 6 cycles of COPP/ABV chemotherapy. Thereafter, he had received oral mephalan and prednisolone without disease progression for 12 months. At 27-month follow-up, he succumbed to overwhelming pneumonia and septic shock with progressive disease of MM. We present this case as a first report of simultaneous occurrence of HD and MM in South Korea.
Aged ; Disease Progression ; Drug Therapy ; Follow-Up Studies ; Hodgkin Disease* ; Humans ; Korea ; Multiple Myeloma* ; Pneumonia ; Prednisolone ; Sclerosis ; Shock, Septic

OBJECTIVES: A lots of studies have investigated the psychosocial characteristics of suicidal attempters in order to find efficient coping strategy and treatment intervention. The purpose of this study was to examine the psychosocial factors affecting the suicide attempt in psychiatric patients. METHODS: Two hundred eighty patients who attempted suicide and admitted in the emergency room in 3 university hospitals from December 2003 to May 2006 were recruited in this study. The patients were interviewed using Structured Clinical Interview for DSM-IV Axis I disorder (SCID-RV), Lethality of Suicide Attempt Ratings Scale (LSARS) and Risk-Rescue Rating system (RRR). RESULTS: The suicide attempters have psychosocial characteristics of female preponderance, age 20-39, high school in educational level, married in marriage condition, inoccupation, house makers in occupation. Most of attempters used the nonsevere methods such as drug ingestion or wrist cutting, and selected home as the place of attempt. The delay until discovery was less than 4 hours for most suicide attempters, and the rate of asking for help directly or dropping clues were high. Major depressive disorder was the most common psychiatric illness among attempters. Conclusions: The present study would be the early stage to explore the risk factor and protect factor of suicidal attempt. This study suggests that the closed observation to potential-suicidal attempter in daily life is critical to protect against the fatal results due to suicidal attempts.
Axis, Cervical Vertebra ; Bipolar Disorder ; Depression ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Eating ; Emergency Service, Hospital ; Epidemiology ; Female ; Hospitals, University ; Humans ; Marriage ; Occupations ; Psychology* ; Risk Factors ; Schizophrenia ; Suicide* ; Suicide, Attempted ; Wrist

BACKGROUND: Off-pump coronary artery bypass (OPCAB) patients often require fluid, vasopressor, or inotropic support.It is therefore important that vigilant monitoring be undertaken to guide intervention and monitor the effects of therapy.Continuous monitoring of cardiac output (CO) is advisable.The aim of this study was to compare continuous cardiac index (CCI) and stat cardiac index (SCI) with intermittent bolus cardiac index (ICI) in patients undergoing OPCAB surgery. METHODS: Matched sets of CI measurements among CCI, SCI, and ICI were collected in 35 patients undergoing elective OPCAB at specific time periods.Bland-Altman analysis was used to compare the agreement among the different methods. RESULTS: Bland-Altman analysis of CI measurements yielded a bias, precision, and percent error of 0.09 +/- 0.63 L/min/m(2) (46.2%) for CCI and 0.09 +/- 0.60 L/min/m(2) (44.0%) for SCI, compared with ICI measurements. CONCLUSIONS: We found that the agreement of CCI, SCI, and ICI was poor.This disagreement increased during periods of open thorax and open pericardium when compared to the period of closed thorax.Continuous CO measurements through pulmonary artery catheter should be interpreted with caution during OPCAB.
Bias (Epidemiology) ; Cardiac Output ; Catheters ; Coronary Artery Bypass, Off-Pump ; Humans ; Organothiophosphorus Compounds ; Pericardium ; Pulmonary Artery ; Thoracic Surgery ; Thorax