Vertigo mimicking labyrinthine lesions may have resulted from ischemic insult to the inner ear or the vestibular nerve and nucleus in the AICA infarction syndrome. A 56-year-old female was admitted to the emergency room with vertigo and hearing loss in right ear. On neurological examination, she had left beating jerky torsional and horizontal nystagmus with falling and past pointing to right side. Brain magnetic resonance images showed high signal intensity in anterolateral portion of inferior pons on T2- weighted images. Severe right facial palsy of peripheral type developed 24 hours after admission. Audiometry and electronystagmography documented absent auditory and vestibular function on the affected side. We argue that vertigo of the acute infarction in AICA territory can be involved the eight and seventh nerve root entry zoon and mimic labyrinthine lesions
Audiometry ; Brain ; Ear ; Ear, Inner ; Electronystagmography ; Emergency Service, Hospital ; Facial Nerve* ; Facial Paralysis ; Female ; Hearing Loss ; Humans ; Infarction* ; Middle Aged ; Neurologic Examination ; Nystagmus, Pathologic ; Pons ; Vertigo* ; Vestibular Nerve

Vascular injuries which occur during lumbar disk surgery, although rare, can give rise to potentially fatal complications which may be overlooked due to a broad range of clinical manifestations, and which surgeons and radiologists should be aware of. We report a recently encountered case of pseudoaneurysm of the abdominal aorta after lumbar disc surgery, and review the associated literature.
Aneurysm, False* ; Aorta, Abdominal ; Diskectomy* ; Vascular System Injuries

The diagnosis of insulinoma is made primarily by the detection of an inappropriately elevated serum insulin level in the presence of a low blood glucose level. The successful resection of insulin-secreting islet cell turnors is greatly facilitated by accurate preoperative localization. But, the modalities of ultrasonography, computer tomography, magnetic resonance imaging and selective arteriography often fail to detect insulinoma smaller than 1.5 cm in diameter. In this report, we describe a patient with an insulinoma successfully localized by percutaneous transhepatic portal vein sampling but not by abdominal ultrasonography, computer tomography and selective arteriography. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step-up of insulin concentrations near 6 cm from distal splenic vein. During operation, a 1×1.3cm sized tumor was found at the junction of body and tail of pancreas, so distal pancreatectomy was performed, We propose that preoperative percutaneous transhepatic portal vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method and plays an important role to localize insulinoma that are considered occult after conventional diagnostic studies have been negative.
Angiography ; Blood Glucose ; Catheterization ; Catheters ; Diagnosis ; Humans ; Insulin ; Insulinoma ; Islets of Langerhans ; Magnetic Resonance Imaging ; Methods ; Pancreas ; Pancreatectomy ; Portal Vein ; Splenic Vein ; Tail ; Ultrasonography

Nucleolar organizer regions(NORs) are intranucleolar segments of DNA coding for ribosomal RNA and contribute to the regulation of cellular protein synthesis. Since NOR-associated proteins are argyrophilic, silver staining method has been used for demonstration of NORs. The numbers of argyrophilic NORs(AgNORs) have been shown to be correlated with DNA ploidy and have prognostic value in diverse human neoplasms. However, the prognostic value of AgNORs in renal cell carcinoma(RCC) remain ill defined. We herein investigated the prognostic value of AgNORs in 39 patients with RCC. There was no significant relationship between mean number of AgNORs (m AgNORs) per nucleus and Robson stage and Fuhrman nunlear grade. However, there was significant relationship between the percentage of tumor cells with more than five AgNORs per nucleus (p AgNORs) and Robson stage and nuclear grade (p<0.05). There was significant difference in survival rate between patients with RCC in whom AgNORs were two or less and in whom AgNORs were greater than two(p<0.05). The patients with a low p AgNORs(less than 8%) have a better prognosis than those with a high p AgNORs. These results suggest that number of AgNORs may be a clinically useful prognostic marker for patients with RCC.
Carcinoma, Renal Cell* ; Clinical Coding ; DNA ; Humans ; Nucleolus Organizer Region* ; Ploidies ; Prognosis ; RNA, Ribosomal ; Silver Staining ; Survival Rate

The neuroendocrine responses to surgical stress in man include release of ACTH, GH and prolactin in the serum(Cooper and NElson, 1962: Ney et al., 1963: Ross et al., 1966: Schlach, 1967: Gordon et al., 1972: Jeffrey et al., 1977). Data on serum LH and FSH during operation under general anesthesia have been conflictiong. Evidence has also been accumulated that serum LH levels are increased significantly in male patients during operation under general anesthesia in comparison of serum LH in males might be different from that in postmenopausal females with a very high basal level of LH and from menstrating females. Effects of surgical stress under general anesthesia with halothane-N2O on serum LH and FSH levels were studied in 12 menstruating female patients, 8 postmenopausal female patients, and in 8 male patients with no endocrine disorders, liver or kidney function impairment as judged by routine tests. Control serum samples were taken immediately before anesthesia and subsequent samples were obtained from the patients 30 minutes, 1hour and 5~6hours after the onset of anesthesia and on the second and seventh postoperative day. The concentrations of serum LH and FSH were measured by a specific and sensitive radioimmunoassay method. The results are as follows; 1) Preanesthetic levels of serum LH and FSH served as controls and were within range of normal values for male and female subjects in our laboratory. 2) In male patients, serum LH levels 1 hour after onset of anesthesia increased significantly over those of preanesthesia, while no significant intraoperative increase in LH levels was found in female patinets. 3) No significant change in serum LH levels was demonstrated on the second and seventh postoperative day except female patients, who showed significant decrease in the serum LH level on the second postoperative day. 4) No significant intracperative and postoperative changes in serum FSH levels were observed in male or female patients. From the above results, it may be concluded that significant intraopertive increase in serum LH levels occurs in male patients but not in female patients.
Adrenocorticotropic Hormone ; Anesthesia ; Anesthesia, General* ; Female* ; Gonadotropins* ; Humans ; Kidney ; Liver ; Male* ; Prolactin ; Radioimmunoassay ; Reference Values

PURPOSE: We evaluated the clinical and radiological outcomes of double-bundle anterior cruciate ligament (ACL) reconstruction using an outside-in technique with a follow-up of two- to six-years, especially in terms of the sports activity level and radiological degeneration. MATERIALS AND METHODS: Sixty-seven patients who were available for a minimum two-year follow-up after double-bundle ACL reconstruction using an outside-in technique were retrospectively evaluated. The mean follow-up period was 43.7 months. The knee function and stability were evaluated before the operation, one year after the operation (short-term follow-up), and more than two years after the operation (last follow-up). RESULTS: Regarding the knee function, the Lysholm score, International Knee Documentation Committee (IKDC) evaluation, and hop test showed significant improvement. Regarding the stability, the Lachman test, pivot shift test, KT-2000 arthrometer data, and anterior drawer radiographs using Telos showed significant improvement. Regarding the sports activity level, the patients who returned to pre-injury level activity was 68.7% according to the Tegner activity score and 76.1% according to the Cincinnati sports activity scale score. The incidence of aggravated degeneration or development of greater than IKDC grade A degeneration after surgery was 10.4%. CONCLUSIONS: Double-bundle ACL reconstruction using an outside-in technique showed favorable clinical and radiological outcomes with respect to the knee function and stability, joint degeneraion, and, especially, return to pre-injury sports activity.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Follow-Up Studies ; Humans ; Humulus ; Incidence ; Joints ; Knee ; Retrospective Studies ; Sports

PURPOSE: Our examination was designed to determine the diagnostic properties of the cutoff point for the prediction of bacteremia in febrile children less than 3 years of age. Cutoff point is the value that simultaneously maximizes both sensitivity and specificity. METHODS: We conducted a retrospective study of febrile children, less than 3 years of age, who clinically have no identifiable source of fever. Peripheral blood leukocyte count(WBC), absolute neutrophil count(ANC), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured at the same time. All patients received blood culture, urine culture and/or CSF culture. Bacterial infection was defined as single pathogen isolated from the CSF or blood or a urinary tract infection (UTI). Patients were dichotomized into two groups: those with bacterial infection and no bacterial infection. We analyzed the characteristics of the children in the two groups. RESULTS: Seventy-one patients(44 males; 27 females) were enrolled in the study. Twenty patients (28%) had a serious bacterial infection(twelve urinary tract infection, five bacteremia, three meningitis) and fifty-one(72%) had no serious bacterial infection. WBC, ESR and CRP were significantly different between the two groups(P<0.05). The cutoff point of WBC, ESR and CRP were 20,000/mm3, 30 mm/hr and 3.0 mg/dL, respectively. The sensitivity and specificity of each cutoff point were WBC(75%, 75%), ESR(79%, 68%) and CRP(83%, 77%), respectively. CONCLUSION: These data show the ability of predictors to identify febrile children less than 3 years of age with bacterial infection. Febrile children who reach the cutoff point must be treated intensively and those who do not reach the cutoff point can be carefully managed without administering antimicrobial agents.
Anti-Infective Agents ; Bacteremia ; Bacterial Infections* ; Blood Sedimentation ; Child* ; Fever ; Humans ; Leukocytes ; Male ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity ; Urinary Tract Infections

Adenosquamous carcinomas of the intestine are rare tumors, especially when they occur in the small bowel. We report a case of primary adenosquamous carcinoma of the proximal jejunum in a 66 year old woman with no underlying pathologic condition. The tumor mainly consisted of well differentiated squamous cell carcinoma showing keratin pearl and conspicuous intercellular bridges, and minor portion revealed well differentiated adenocarcinoma. The tumor seemed to have originated from the mucosal epithelium, invading the entire wall and metastasizing to the regional lymph nodes. Previous reports of adenosquamous carcinoma of the small intestine have been associated with metastatic disease from distant sites or intestinal duplication. In the colon, squamous cell differentiation have been seen in about 0.05% of adenocarcinomas and in 0.4% of adenomata. The pathogenesis of squamous cell carcinoma of the intestine is unknown, but some possible mechanisms are proposed. :1)malignant transformation of squamous cell epithelium in the submucosa, 2)aberrant differentiation of stem cells to squamous cell with subsequent malignant change, 3)squamous metaplasia of glandular cells with subsequent malignant change, 4)transformation of an adenosquamous into an epidermoid carcinoma.
Adenocarcinoma ; Aged ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Cell Differentiation ; Colon ; Epithelium ; Female ; Humans ; Intestine, Small ; Intestines ; Jejunum* ; Lymph Nodes ; Metaplasia ; Stem Cells

BACKGROUND: Mivacurium is a nondepolarizing neuromuscular blocking agent hydrolyzed by pseudocholinesterase. Anticholinesterase used in the reversal of mivacurium-induced muscle relaxation may also inhibit plasma pseudocholinesterase, and delay hydrolysis of mivacurium. In this study, the effects of edrophonium and/or bovine pseudocholinesterase (BpChE) in the reversal of mivacurium were investigated with the rat phrenic nerve-diaphragm preparation. METHODS: Fifty Sprague-Dawley rats (150 - 200 g) were randomly allocated into 10 groups based on the dosage of edrophonium and BpChE. Each animal was anesthetized with thiopental sodium (40 mg/kg I.P.). The phrenic nerve-diaphragm was dissected and mounted in a bath containing an oxygenated Krebs' solution at 32degreesC. The phrenic nerve was stimulated at supramaximal intensity and the single twitch responses and train of four (TOF) ratio were measured. After stabilization of the twitch responses, mivacurium (1ng/ml) was administered incrementally to obtain more than 95% twitch inhibition. Reversal of the mivacurium-induced block by edrophonium (0.01, 0.1, 1, or 10ng/ml) and/or BpChE (0.1 u, or 1.0 u/ml) were tested. A single twitch height more than 75% of the baseline value was considered an adequate reversal. RESULTS: Mivacurium-induced paralysis was recovered more effectively by BpChE 1.0 u/ml than the other groups. Edrophonium improved a single twitch in a dose dependent manner. CONCLUSIONS: Mivacurium-induced paralysis can be more effectively reversed by BpChE than edrophonium. Inhibition of pseudocholinesterase was not observed by increasing the dose of edrophonium.
Animals ; Baths ; Edrophonium* ; Hydrolysis ; Muscle Relaxation ; Neuromuscular Blockade ; Oxygen ; Paralysis* ; Phrenic Nerve ; Plasma ; Pseudocholinesterase* ; Rats ; Rats, Sprague-Dawley ; Thiopental

BACKGROUND: A sizable percentage of tuberculous pleurisy patients are known to have residual pleural thickening(RPT) despite adequate anti-tuberculous chemotherapy. But, the predictive factors related to the development of RPT is not well known. Therefore, we studied to determine which factors are related to the development of RPT after completion of therapy. METHODS: By retrospective review of medical records, fifty-eight patients initially diagnosed as having tuberculous pleurisy between March 1995 and January 1998 were separated into two groups: 27 patients in group 1 had RPT on simple chest radiography, while 31 patients in group 2 had no RPT after 6 month of anti-tuberculous chemotherapy. The clinical characteristics, radiologic findings and pleural fluid findings of the two group were compared at the time of diagnosis and during the course of therapy. RESULTS: 1) 47% of patients had RPT after 6 month of chemotherapy, and RPT was more common in man than in women(54% vs 29%,p=0.092). 2) In group 2 patients, complete resorption of pleural lesion occurred rather late stage of therapy(1-2 month : 26%, 3-4 month :29%, 5-6 month : 45%). 3) Group 1 patients had increased percentage of loculated pleural lesion(26% vs 19%) and increased white blood cell and lymphocyte count, lactate dehydrogenase level in pleural fluid (3527+/-5652 vs 2467+/-2201/ml, 2066+/-2022 vs 1698+/-1835/ml and 1636+/-1143 vs 1441+/-923IU/ml, respectively) than group 2 at the time of diagnosis, but statistically insignificant. 4) Duration of symptom prior to treatment, size of pleural effusion, presence of parenchymal lung lesion, level of total protein, glucose and adenosine deaminase(ADA) activity in pleural fluid were similar in both group. CONCLUSION: 53% of tuberculous pleurisy patients showed slow but complete resorption of pleural lesion after 6 month of chemotherapy. But, no clinical, radiological and pleural fluid findings are predictive for the development of RPT.
Adenosine ; Diagnosis ; Drug Therapy ; Glucose ; Humans ; L-Lactate Dehydrogenase ; Leukocytes ; Lung ; Lymphocyte Count ; Medical Records ; Pleural Effusion ; Radiography ; Retrospective Studies ; Thorax ; Tuberculosis, Pleural*