Congenital anomalies of the pancreaticobiliary structure may go undetected until adulthood, and they can be the cause of unexplained jaundice, abdominal pain, nausea and vomiting. In addition to such associated disease, as cholangitis, gallstone, cholangiocarcinoma and pancreatitis, recognition of these variant anatomies is clinically important for planning surgery and for preventing inadvertent surgical injury. Although congenital abnormalities and variations of the biliary ducts are common, and variations in the drainage and course of the cystic duct are also frequently seen, variation of the cystic duct opening into the right hepatic duct is rare; further, it is important to avoid erroneous ligation of the hepatic duct during surgery. We report here on a case of aberrant cystic duct opening into the right hepatic duct along with acute pancreatitis.
Abdominal Pain ; Cholangiocarcinoma ; Cholangitis ; Congenital Abnormalities ; Cystic Duct* ; Drainage ; Gallstones ; Hepatic Duct, Common* ; Intraoperative Complications ; Jaundice ; Ligation ; Nausea ; Pancreatitis* ; Vomiting

The human rabies is a fatal infectious disease invading the central nervous system. There are many cases of clinically suspicious human rabies encephalitis in Korea since 1906. A 53-year old man was admitted to the Department of Neurology because of rapidly progressive dysphagia. His sputum was examined and the rabies virus was found by the polymerase chain reaction technique. So we report a case of human rabies encephalitis confirmed by detection of the rabies virus from his saliva.
Central Nervous System ; Communicable Diseases ; Deglutition Disorders ; Encephalitis ; Humans* ; Korea ; Middle Aged ; Neurology ; Polymerase Chain Reaction* ; Rabies virus ; Rabies* ; Saliva ; Sputum

OBJECTIVE: The tolerance and the safety of temporary arterial occlusion in aneurysm surgery are variable among patients because of individual variations of their collateral circulation. We recorded continuous intraoperative regional cortical blood flow(rCoBF) with thermal diffusion flowmetry(TDF) in patients with aneurysmal subarachnoid hemorrhage to determine a safe time limit for temporary occlusion in relation to rCoBF. PATIENTS AND METHODS: From Oct. '97 to Sep. '98, 40 patients with cerebral aneurysm at anterior cerebral artery(ACA) or middle cerebral artery(MCA) were included in this study. The TDF probe was placed over the cortex which was supplied by corresponding arteries. For data analysis, we included only the patients with Hunt-Hess grade I or II on admission. RESULTS: The total occlusion time of the proximal parent artery in 24 patients was on average 21.8 minutes, ranging between 9 minutes and 68 minutes. The lowest rCoBF in relation to temporary occlusion time in patient with excellent outcome was as follows: 0ml/100mg/min for 13 minutes and 6ml/100mg/min(11% of basal rCoBF) for 18 minutes in the middle cerebral artery and bilateral anterior cerebral arteries, respectively. The multiple regression equation regarding safe time for temporary clipping was as follows: safe time = 5.5 + 0.06 X rCoBF intra + 0.25 X rCoBF pre. And reperfusion time for the full recovery of rCoBF was within 4 minute in most cases, except some no-reflow cases. CONCLUSION: In our study with proper brain protection, a safe time limit for temporary occlusion was calculated 18 minutes even at 0ml/100mg/min in the MCA and this technique seems to be very useful to detect a continuous real time change of rCoBF during aneurysm surgery.
Aneurysm* ; Anterior Cerebral Artery ; Arteries ; Brain ; Collateral Circulation ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Parents ; Reperfusion ; Statistics as Topic ; Subarachnoid Hemorrhage ; Thermal Diffusion

Segmental myoclonus can be seen in variable lesions of the brainstem or spinal cord, but the pathophysiology of the segmental myoclonus is not fully defined yet. We describe three patients with delayed developed and chronically persisted involuntary movement restricted to one arm after mild cervical injury. Myoclonus developed 1 month later in 2 patients and the other 5 months later after the injury. They suffered from myoclonus for more than 2 months, 1 year, and 25 years, respectively. Clonazepam and phenytoin were tried, but not satisfactory.
Arm ; Brain Stem ; Clonazepam ; Dyskinesias ; Humans ; Myoclonus* ; Phenytoin ; Spinal Cord

Segmental myoclonus can be seen in variable lesions of the brainstem or spinal cord, but the pathophysiology of the segmental myoclonus is not fully defined yet. We describe three patients with delayed developed and chronically persisted involuntary movement restricted to one arm after mild cervical injury. Myoclonus developed 1 month later in 2 patients and the other 5 months later after the injury. They suffered from myoclonus for more than 2 months, 1 year, and 25 years, respectively. Clonazepam and phenytoin were tried, but not satisfactory.
Arm ; Brain Stem ; Clonazepam ; Dyskinesias ; Humans ; Myoclonus* ; Phenytoin ; Spinal Cord

BACKGROUND: The sodium/iodide symporter (NIS) is a membrane glycoprotein that facilitates the uptake of iodine by thyroid follicular cells. Although the use of radioiodide is essential for the diagnosis and treatment of thyroid diseases, few studies have been conducted to investigate the use of NIS-mediated radioiodide accumulation in lung cancer. We evaluated the expression of NIS by immunohistochemistry in order to examine the diagnostic or therapeutic feasibility of using radioiodide in the treatment of primary lung cancer. METHODS: Immunohistochemistry for NIS was performed in 139 lung cancers. The expression pattern of NIS was compared with the clinicopathological characteristics of the tumors. RESULTS: NIS immunoreactivity was detected in 75 (54.0%) of the 139 cases. Twenty-three (37.7%) of the 61 squamous cell carcinomas, 49 (76.6%) of the 64 adenocarcinomas, 2 (40.0%) of the 5 small cell carcinomas, and 3 (33.3%) of the 9 other carcinomas showed positive NIS immunoreactivity. The expression of NIS was significantly associated with the histologic type (p<0.001), but it did not correlate with tumor size, lymphovascular invasion or lymph node metastasis. CONCLUSIONS: The presence of NIS was detected in lung cancer tissue using immunohistochemistry. Lung cancer potentially could be targeted with radioiodide for both diagnosis and treatment, especially in cases of adenocarcinoma.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Immunohistochemistry ; Iodine ; Ion Transport* ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Membrane Glycoproteins ; Neoplasm Metastasis ; Thyroid Diseases ; Thyroid Gland

PURPOSE: Some advanced countries have reported annual statistics for poisoning based on data from poison control centers. This study was conducted to propose a baseline format and statistics of poisoning in Korea from a national representative database. METHODS: This study was a retrospective analysis of poisoning patients based on data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2016. Bite or sting injuries were not included. Variables related to poisoning were summarized using a similar format as the National Poison Data System in the United States. RESULTS: A total of 7,820 poisoning patients presented to 23 EDs. Adults ≥20 years accounted for 84% of the population, while the proportion of intentional poisoning was 59.4%. The most common poisoning substances were therapeutic drugs (45%), gas (21%), pesticides (15%), and artificial toxic substances (13%). Overall, 34.5% of patients were admitted for further treatment. The mortality was 3.2% (248 cases), and the most common causative substances were carbon monoxide, glyphosate, and paraquat, in order. CONCLUSION: This study showed the recent status of poisoning in Korea. However, a comprehensive poisoning registry based on poison control centers may be required to provide more accurate national statistics in the future.
Adult ; Bites and Stings ; Carbon Monoxide ; Centers for Disease Control and Prevention (U.S.) ; Drug Overdose ; Emergency Service, Hospital ; Humans ; Information Systems ; Korea ; Mortality ; Paraquat ; Pesticides ; Poison Control Centers ; Poisoning* ; Retrospective Studies ; United States

A 39-year-old woman developed Wernicke's encephalopathy in the sixteenth week of her pregnancy after eight weeks of severe nausea and vomiting. Because of her protracted severe vomiting, she had inpatient treatment with intravenous dextrose and electrolytes without thiamine. In her fourteenth week of pregnancy, she began showing neurologic symptoms such as dizziness, tinnitus, hearing impairment, nystagmus and ataxia. To rule out possibility of brain stem lesions, MRI of brain was performed. MRI showed tectal lesions as well as bilateral symm-etric midline lesions along the third ventricle and cerebral aqueduct. Further evaluate for these lesions, FLAIR(fluid-attenuated inversion-recovery) MR imaging was performed. Based on her clinical symptoms and FLAIR MR imaging, she was diagnosed as Wernicke's encephalopathy. Combined therapy with vitamin B1(50mg/day) and steroid(met-hylprednosolone 1g/day) was immediately started. Two days later, her neurologic symptoms improved. FLAIR imaging technique allows easier identification of specific periventricular distribution of the lesions. The preventive steroid therapy may have resulted in beneficial outcome on Wernicke's encephalopathy.
Adult ; Ataxia ; Brain ; Brain Stem ; Cerebral Aqueduct ; Dizziness ; Electrolytes ; Female ; Glucose ; Hearing Loss ; Humans ; Hyperemesis Gravidarum* ; Inpatients ; Magnetic Resonance Imaging ; Nausea ; Neurologic Manifestations ; Pregnancy ; Thiamine ; Thiamine Deficiency ; Third Ventricle ; Tinnitus ; Vitamins ; Vomiting ; Wernicke Encephalopathy*

An inferior accessory ossicle of the anterior arch of the atlas is quite rare and should not be confused with other pathological conditions such as a fracture. Here we report a case of an inferior accessory ossicle of the anterior arch of the atlas in a 29-year-old male and a review of literature.
Adult ; Humans ; Male

Purpose: The annual statistics for poisoning are reported based on the data from poison control centers in many advanced countries. In 2016 a study was conducted to analyze the 2016 Korea Poisoning status. This study was conducted to make a better annual report for poisoning statistics in Korea from a 2017-2018 national representative database. Methods: This study was a retrospective analysis of poisoning patients based on the data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2017-2018. Bite or sting injuries were not included. Results: A total of 17714 patients presented to 23 EDs because of poisoning. Adults above 20 years old age accounted for 84.6% of the population, while the proportion of intentional poisoning was 60.8%. The poisoning substance presented in the ED were therapeutic drugs (51.2%), gas (20.3%), pesticides (16.4%), and artificial substances (11.4%). Overall, 35% of patients were admitted for further treatment. The mortality was 2.4% (422 cases), and the most common fatal substances in order were carbon monoxide, other herbicides, and paraquat. Conclusion This study showed the 2017-2018 status of poisoning in Korea. The prognosis is different from the cause of poisoning and the initial mental state of the patient. Therefore, appropriate methods for preventing poisoning and therapeutic plans in specific situations are needed.