OBJECTIVE: For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described). METHODS: A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs). RESULTS: The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days. CONCLUSION: Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.
Abducens Nerve Diseases ; Exophthalmos ; Female ; Fistula* ; Humans ; Orbit ; Punctures* ; Veins* ; Young Adult

Glucocorticoids are usually given according to a standard dosing protocol regardless of individual difference. We evaluated the pharmacokinetic characteristics of methylprednisolone and the degree of interpatient variation in stable Korean renal transplant recipients during the period of 15-21 days after transplantation. This study included 23 renal transplant recipients, 13 males and 10 females, who received kidneys from living donors with stable graft function and without episode of acute rejection. On the study day at 8 A.M., 16.3mg of ethylprednisolone sodium succinate (i.v.) was administered to each patient instead of usual dose (20mg) of prednisolone (p.o.) after sampling of 7cc of baseline blood and additional blood samples were drawn after starting infusion. Plasma was separated and analyzed for methylprednisolone level using high performance liquid chromatography (HPLC) assay, and parameters for pharmacokinetics were calculated. There was significant interpatient variation in the pharmacokinetics of methylprednisolone in our patients group. There was no significant difference in the pharmacokinetic parameters between patients with and without side effects of steroid. Korean renal transplant recipients had higher volume of distribution than black renal transplant recipients; lower clearance than white renal transplant recipients; longer t1/2 than both black and white renal transplant recipients. Even if the number of patients included in this study was too small to reach conclusion, the differences in the pharmacokinetics of glucocorticoids do not seem to be a significant risk factor for side effects of steroid after transplantation. It may be necessary to individualize the dose of a glucocorticoid to achieve an optimal effect and also we need to establish a new steroid regimen protocol for Korean renal transplant recipients.
Chromatography, Liquid ; Female ; Glucocorticoids ; Humans ; Individuality ; Kidney ; Kidney Transplantation ; Living Donors ; Male ; Methylprednisolone* ; Pharmacokinetics ; Plasma ; Prednisolone ; Risk Factors ; Sodium ; Succinic Acid ; Transplantation* ; Transplants

A new microemulsion formulation of cycloporine(CsA) has been recently used in Korean renal transplants. We compared the clinical effect and the trough levels of microemulsion cyclosporine(M-CsA) as opposed to conventional CsA in soft gelatine capsule(C-CsA). In the study for hospitalized post-operative patients, 58 patients were divided into two groups; the C-CsA(control) group(n=23) received C-CsA, and the M-CsA group(n=28) received M-CsA after transplantation. In the study for stable OPD patients, 32 patients were divided into two groups. The C-CsA(control) group(n=16) did not change the type of CsA and continued C-CsA medication after Sep. 1994, M-CsA group(n=16) switched from C-CsA to M-CsA in Sep. 1995. In postoperative hospitialized patients, mean trough levels were not different between the two groups with CsA dosage (9mg/kg - 5mg/kg), although the M-CsA group had higher trough levels with 10mg/Kg CsA dosage than the control group. In OPD patients, there was no significant change in CsA dosage in both groups during the 6 month period. Mean trough levels, 6 months after conversion, were lower in the M-CsA group than in the control group. In the M-CsA group who received the same dose as a preconversion dose, mean trough levels at 2, 3, 4, 5, 6 months were lower than the preconversion level, although control groups had lower trough levels only at 5 months. Serum creatinine levles were significantly decreased in the M-CsA OPD patients. From these results, we couldn't find a dose saving effect of M-CsA in our patients, it is much desirable to study the pharmacokinetics of M-CsA and C-CsA in Korean renal transplants.
Creatinine ; Cyclosporine* ; Gelatin* ; Humans ; Kidney Transplantation ; Pharmacokinetics ; Transplantation*

To determine whether age, weight, height, vertebral column length, body mass index, or abdominal circumference might influence the distribution of sensory analgesia after epidural anesthesia, 100 women presenting for cesarean section were studied. All received 26 mg of 2.0% lidocaine mixed with 8.4% bicarbonate 1 ml/lidocaine 10 ml and 1:300,000 epinephrine, including 3 ml of test dose, through the epidural catheter inserted in L3-4 interspace. While the women lay supine on a horizontal operating table with the air bag under their right hip, 2, 5, 10, 20, and 30 minutes after injection, the cephalad extent of sensory analgesia (loss of sensation of sharpness to pin prick) was determined. Age (31.9+/-3.8 years), weight (69.2+/-9.3 kg), height (158.9+/-4,5 cm), vertebral column length (59.8+/-5.0 cm), body mass index (27.4+/-3.2 kg/m(2)), and abdominal circumference (103.5+/-10.2 cm) did not correlate with the maximum level of sensory analgesia. In conclusion, in parturients of age, weight, height, vertebral column length, body mass index and aMominal circumference of the above values, it is not necerrary to vary dose of injected local anesthetics with changes in any of the patient variables studied.
Air Bags ; Analgesia ; Anesthesia, Epidural* ; Anesthetics, Local ; Body Mass Index ; Catheters ; Cesarean Section* ; Epinephrine ; Female ; Hip ; Humans ; Lidocaine ; Operating Tables ; Pregnancy ; Sensation ; Spine

PURPOSE: We wanted to evaluate the clinical utility of performing bilateral whole breast US as a subsequent diagnostic method along with mammography in asymptomatic women. MATERIALS AND METHODS: From May 2002 to Dec 2004, we conducted 3998 examinations on 3638 patients with negative findings on the clinical examination and negative mammographic results, and those breast tissues having a BI-RADS category 2, 3, or 4 density were further evaluated by performing bilateral whole breast US. The patients' age distribution ranged from 24 to 66 years (mean age: 43.6 yrs). The abnormalities were compared with core or vacuum assisted core biopsy, operations, and follow up US. For the normal cases, we used the clinical notes and the statistical data from the Korean Central Cancer Registry. RESULTS: For 3998 examinations of 3638 women who were examined with bilateral whole breast US, pathologic confirmations were available for 433 patients and follow-up data were available for 35 patients. The sensitivity, specificity, the positive predictive value and the cancer detection rate of using additional whole breast US were 50, 92.6, 0.6 and 0.5, respectively. The two cancers that were detected only on US were minimal breast cancer. CONCLUSION: Although all the breast cancers that were detected only on US were minimal breast cancers, performing bilateral whole breast US revealed a low cancer detection rate and a high false positive. Therefore, further studies will be needed to investigate the role of US as a screening tool.
Age Distribution ; Biopsy ; Breast Neoplasms ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammography ; Mass Screening ; Sensitivity and Specificity ; Vacuum

We are report a case of surgically treated a huge neurilemmoma in the lower thoracic and lumbosacral areas. A 57-year-old women presented with low back pain, motor weakness of the both lower extremities and urination difficulty. Magnetic resonance imaging revealed a huge enhancing lesion at the L3-S1 levels and isolated two small enhancing lesions at the T12 and L1 level respectively. This case was treated with extensive laminectomy from T12 through S1 level and total resection. The pathological findings were consistent with neurilemmoma. The patient's preoperative neurologic deficit has been recovered and no postoperative complications developed.
Cauda Equina* ; Female ; Humans ; Laminectomy ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Neurilemmoma* ; Neurologic Manifestations ; Postoperative Complications ; Urination

Proper seat belt use saves lives; however, the use rate decreased in Korea. This study aimed to measure the magnitude of the preventive effect of seat belt on case-fatality across drivers and passengers. We used the Emergency Department based Injury In-depth Surveillance (EDIIS) database from 17 EDs between 2011 and 2012. All of adult injured patients from road traffic injuries (RTI) in-vehicle of less than 10-seat van were eligible, excluding cases with unknown seat belt use and outcomes. Primary and secondary endpoints were in-hospital mortality and intracranial injury. We calculated adjusted odds ratios (AORs) of seat belt use and driving status for study outcomes adjusting for potential confounders. Among 23,698 eligible patients, 15,304 (64.6%) wore seat belts. Driver, middle aged (30-44 yr), male, daytime injured patients were more likely to use seat belts (all P < 0.001). In terms of clinical outcome, no seat belt group had higher proportions of case-fatality and intracranial injury compared to seat belt group (both P < 0.001). Compared to seat belt group, AORs (95% CIs) of no seat belt group were 10.43 (7.75-14.04) for case-fatality and 2.68 (2.25-3.19) for intracranial injury respectively. In the interaction model, AORs (95% CIs) of no seat belt use for case-fatality were 11.71 (8.45-16.22) in drivers and 5.52 (2.83-14.76) in non-driving passengers, respectively. Wearing seat belt has significantly preventive effects on case-fatality and intracranial injury. Public health efforts to increase seat belt use are needed to reduce health burden from RTIs.
Accidents, Traffic/mortality/*prevention & control ; Adult ; Aged ; Craniocerebral Trauma/prevention & control ; Databases, Factual ; Emergency Service, Hospital ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Motor Vehicles ; Odds Ratio ; Republic of Korea/epidemiology ; Seat Belts/*utilization ; Young Adult

We studied the chronic renal allograft dysfunction in Korean renal transplants from 1 year after transplantation to 5 years. We evaluated renal function by simply using the reciprocal serum creatinine level and sought to find factors affecting the value of the reciprocal serum creatinine and graft survival, and changes of the slope of reciprocal serum creatinine. We also estimated the reciprocal serum creatinine from demographic parameters and routine laboratory results. This study included 114 patients, 87 male and 27 female who underwent renal transplantations and had functioning allografts for more than 18 month after transplantation. The results were as follows. 1) The reciprocal serum creatinine level decreased slowly and linearly. 2) There were many factors related to the reciprocal creatinine, including blood urea nitrogen, serum uric acid level, age of donors, sex of recipients, presence of acute rejecton, age of recipient, serum phosphorus, white cell count in blood, cyclosporine level in blood, hemoglobin level, posttransplantation period. We could derive the estimated reciprocal serum creatinine from data of the patients. 3) The age of the recipient and cyclosporine level at 1 year after transplantation affected the slope of the reciprocal serum creatinine during follow-up time. 4) There were 16 graft loss, including 3 functioning graft loss and 13 graft loss due to chronic allograft dysfunction. 5) Besides creatinine and BUN level at 1 year, higher blood pressure and proteinuria and lower hemoglobin levels at 1 year after transplantation were related to the graft loss from chronic allograft dysfunction. 6) There were more chronic allograft loss in patients who had lower actuarial reciprocal serum creatinine than estimated reciprocal serum creatinine. Because follow-up time was relatively short and there were only mild increases in serum creatinine level in our study, follow up of our patients for a longer-term period is required to find other factors affecting the renal allograft dysfunction.
Allografts* ; Blood Pressure ; Blood Urea Nitrogen ; Cell Count ; Creatinine ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation ; Male ; Phosphorus ; Proteinuria ; Tissue Donors ; Transplants ; Uric Acid

During temporomandibular joint (TMJ) formation, discomalleolar ligament (DML) and anterior malleolar ligament (AML) are formed within the dorsal end of the 1st branchial arch. But, DML is known as a remnant or the degenerated tissue through the TMJ development. There is few reports said that damage of AML and DML cause the damage of middle ear during surgical procedures. Especially, in case of anterior disk displacement of TMJ, aural symptom can be made via DML due to hyperextension anteriorly. A few studies have been reported about DML and AML in embryological and histological points of view, morphology and clinical aspects of DML and AML are still unclear. Four fetuses and sixteen adult hemi -sectioned heads were dissected to clarify the topographical relationship of AML and DML and to find out the anatomico -clinical relevance related with temporomandibular disorder. In fetal specimens, DML was firmly attached from the disk of the TMJ to the malleus. Also, AML in which distinguished into the superior and inferior lamellae was running anteriorly and continuous with the sphenomandibular ligament (SML) through the future petrotympanic fissure (PTF). DML attached to the malleus was observed in all adult specimens and was expanded broadly to the disk and capsule of the TMJ as shown the V -shaped ligament structures. The average distance between the anterior aspects of the malleolar head to the anterior wall of the tympanic cavity was 1.13 mm(0.75 ~1.59), and the length of the DML from the anterior aspect of the malleolar head to the attached site to the TMJ capsule at the PTF was 5.37 mm (4.53 ~6.07). The average width of the DML at the PTF was 6.06 mm (4.72 ~7.46). Most of the posterior attachments of the DML were the cases in which DML was directly attached to the malleus (68.7%). In all specimens, DML was attached to the disk and capsule of TMJ and attached to the anteromedial border of the PTF concurrently. In this study, two morphological patterns of AML were observed according to the presence of the bony ridge on the Huguiers canal in the PTF. The bony ridge of the Huguiers canal showed DML and AML separately in 56.3%, and the fused pattern of DML and AML was observed in 43.7%. AML was not distinguished with two lamellae in most specimens, superior ligament fibers were attached to the anteromedial border of the PTF and most of the inferior lamella was entering the gap in PTF and continuous with the SML. Average length from the anterior aspect of the malleolar head to the exit point of the AML on the PTF was 8.40 mm(6.62 ~11.42), and the shortest distance between the AML and chorda tympani was 2.01 mm(1.25 ~3.02). Taken all together, DML and AML were not the rudimentary, but the distinguishable structures in adults. Through the various morphological findings, DML and AML were separated ligamentous structures in which might be given rise from the divergent origin. And the anterior hyperextension of the disk of TMJ did not lead the movement of the malleus in the tympanic cavity, whereas, the movement of the malleus followed by the traction of the AML and SML was observed in a few cases. So, this results can be explained the possibility of the clinical symptom on the middle ear in case of the over -traction of the AML and SML.
Adult* ; Branchial Region ; Chorda Tympani Nerve ; Ear, Middle ; Fetus* ; Head ; Humans* ; Ligaments* ; Malleus ; Running ; Temporomandibular Joint ; Temporomandibular Joint Disorders ; Traction

PURPOSE: The in vitro dissolution of intrahepatic stones was evaluated using the various solvent mixtures. MATERIALS AND METHODS: Sixty four intrahepatic stones from 16 patients were used. Four kinds of solvent mixtures(No. 1 = basic buffer + EDTA, No. 2=1 + Sulfobetain-12, No. 3=2 + N-acetylcysteine, No. 4=3 + urea) were used. Dissolution rates were determined by measuring the weight loss of stones after 6, 12, 24, 48 hours incubation periods, respectively. RESULTS: The highest dissolution rates in dissolving intrahepatic stones were achieved with No. 4 solvent mixture(1% W/V EDTA/80mM, Sulfobetain-12/1 M, urea, pH 9.5). CONCLUSION: lntrahepatic stones could be largely dissolved up to about 70% of their initial weight after 48 hours incubation period in vitro.
Acetylcysteine ; Edetic Acid ; Humans ; Hydrogen-Ion Concentration ; Urea ; Weight Loss