A 4year old female admitted for the management of degloving injury of popliteal area. The patient was injuried by traffic accident, and underwent emergency sugery for irrigation and debriment of wound area under halothane anesthesia. She has the 2nd administration of halothane in a period of 18days Two days after the 2nd anesthesia, the patient began to suffer from acute hepatitis with increasing SGOT/SGPT. The patient was cared for at the department of pediatrics and had 3rd operation after 38days and was discharged after 71 days hospitalization.
Accidents, Traffic ; Anesthesia ; Anesthesia, General* ; Child* ; Emergencies ; Female ; Halothane ; Hepatitis* ; Hospitalization ; Humans ; Pediatrics ; Wounds and Injuries

The author analyzed the r-CBF data of 19 patients who admitted to the Kyung Hee University Medical Center under the diagnosis of definite "Moyamoya" disease from 1983 to 1992. Seven of them were followed-up from 1 to 18 months. The results were as fllow : 1) In moyamoya disease patients, the mean hemispheric r-CBF has a tendency to be lower than that of healthy persons. 2) In moyamoya disease patients, the ipsilateral r-CBF also shows a tendency to be lower than that of contralateral side. 3) The 133Xe-inhalation method is one of useful methods to evaluate CBF in Moyamoya disease, especially for follow-up. 4) The results of follow-up study for Moyamoya disease by 133Xe-inhalation method corelate very well with the change in clinical status of the patients. 5) In Moyamoya disease patients, the follow-up by means of 133Xe-inhalation method is one of useful methods to select a good candidate for surgical treatment such as STA-MAC anastomosis.
Academic Medical Centers ; Diagnosis ; Follow-Up Studies ; Humans ; Moyamoya Disease*

OBJECTIVE: The authors conduct a retrospective study to analyze long-term complications of Gamma knife radiosurgery for cerebral arteriovenous malformation(AVM). METHODS: We performed a detailed long-term follow-up study of 100 patients, who could be followed more than 2 years, with AVMs treated by Gamma knife radiosurgery during the last 10 years. At the time of radiosurgery, the mean age was 31.6 years(range : 7-65). The mean follow-up period after radiosurgery was 63.7 months(range : 24-116) except one mortality related with rebleeding. Mean target volume was 5039.2mm3(range : 105-38400). In all of the patients, AVMs were completely covered with a 40-80% isodose profile. The selected target dose delivered by the Gamma Knife was 7.2 to 33 Gy(mean : 22.2 Gy) at the periphery. RESULTS: Angiographic complete obliteration rate was 80% at 2 years after radiosurgery. Rebleeding occur in 4 cases at 4, 8, 44, 98 months after radiosurgery, respectively. Annual bleeding rate was 0.6%. Among them, one patient died. Postradiosurgical complications consisted of adverse radiation effects (ARE) in 19 patients, cyst formation in three, and asymptomatic vascular stenosis in one. Symptomatic ARE was 8% and the mean time from the last radiosurgery to ARE was 12.4 months(1-29) on follow-up images. Three patients, who have been verified angiographically complete obliteration, developed cyst formation within previous irradiated area at 48, 102, 115 months after radiosurgery respectively. Two of them underwent cystic aspiration with catheter drainage. CONCLUSION: The individual incidence of postradiosurgical complication was approximately from 3 to 19%, which is higher than expected. Long-term follow-up is mandatory even after complete nidus obliteration.
Arteriovenous Malformations* ; Catheters ; Constriction, Pathologic ; Drainage ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Mortality ; Radiation Effects ; Radiosurgery* ; Retrospective Studies

No abstract available.
Diabetes Mellitus, Type 2* ; Humans

We report a case of pulmonary fibrosis in a 32-year-old man, who had worked at a steel mill and who died of respiratory failure due to interstitial fibrosis despite vigorous treatment. He showed SLE-associated symptoms, such as pleural effusion, malar rashes, discoid rashes, arthritis, leukopenia, and positive antinuclear antibody and anti-histone antibody. However, he did not present anti-DNA antibody. A thoracoscopic lung biopsy showed interstitial fibrosis, chronic inflammation and a small non-caseating granuloma in lung tissues, which could be induced by external agents such as metals. The manganese concentration in the lung tissue was 4.64 microg/g compared to 0.42-0.7 microg/g in the controls. The levels of other metals, such as iron, nickel, cobalt and zinc in patient's lung tissue were higher than those in the controls. The patient was probably exposed to Si and various metal dusts, and the lung fibrosis was related to these exposures. Exposure to Si and metal dusts should be sought in the history of any patient with SLE, especially in a male with pulmonary signs, and if present, exposure should be stopped. In the meantime, steps should be taken to ensure that workers exposure to Si and metal dusts in all environments have adequate protection.
Adult ; Biopsy ; Case Report ; Fatal Outcome ; Human ; Male ; Occupational Diseases/radiography* ; Occupational Diseases/pathology ; Occupational Diseases/chemically induced* ; Occupational Exposure ; Pulmonary Alveoli/pathology ; Pulmonary Fibrosis/radiography* ; Pulmonary Fibrosis/pathology ; Pulmonary Fibrosis/chemically induced* ; Respiratory Insufficiency/radiography ; Respiratory Insufficiency/pathology ; Respiratory Insufficiency/chemically induced ; Steel/adverse effects*

Three cases of cerebral rete mirabile associated with aneurysms are presented. In two cases the aneurysms were located at the anterior communicating arteries, and in one at the peripheral portion of the middle cerebral artery. For the anterior communicating artery aneurysms, operations were performed. Based on these experiences, the difficulties and necessities of operations for the aneurysms associated with cerebral rete mirabilies are briefly discussed.
Aneurysm* ; Arteries ; Intracranial Aneurysm ; Middle Cerebral Artery ; Mirabilis ; Moyamoya Disease*

We report a first case of meningitis due to listeria monocytogenes after cardiac transplantation in Korea. This patient is a 40-year-old man with Dilated cardiomyopathy, he presented with intermittent dyspnea and abdominal distension for about 1 year. After cardiac transplantation, he was treated with azathioprine, cyclosporine and prednisolone for graft rejection. He was presented with intermittent fever, headache and lethargy for about 10days after cardiac transplantation. Listeria monocytogenes was isolated from blood culture and CSF culture. He was treated with intravenous penicillin G for 10days successfully and changed with ampicillin for 10days, took oral ampicillin for 10days without any complication after discharge.
Adult ; Ampicillin ; Azathioprine ; Cardiomyopathy, Dilated ; Cyclosporine ; Dyspnea ; Fever ; Graft Rejection ; Headache ; Heart Transplantation* ; Heart* ; Humans ; Korea ; Lethargy ; Listeria monocytogenes* ; Listeria* ; Meningitis* ; Penicillin G ; Prednisolone

Spontaneous coronary artery dissection (SCAD) is a rare disease that occurs most commonly in young people, especially in peripartum or postpartum women. It is usually catastrophic and fatal. The etiology of dissection is still under discussion. Possible factors are inflammation, changes of flow dynamics, and preexisting intima lesions. The treatment of choice for spontaneous coronary artery dissection is still not settled. The authors report a twenty-nine year-old woman with coronary lesions diagnosed as spontaneous coronary artery dissection which developed during exercise and was treated with intracoronary stenting.
Coronary Vessels* ; Female ; Humans ; Inflammation ; Peripartum Period ; Postpartum Period ; Rare Diseases ; Stents*

OBJECTIVES: ICAM-1, VCAM-1, and betal integrins mediate cell-cell or cell-matrix interactions. We investigated effects of mixed leukocyte reaction (MLR), cyclosporine A (CsA), or hydrocortisone (HC) on their expression by endothelial (EnC) and mesangial cells (MC). METHODS: MLR was performed with or without CsA or HC for 5 days. After adding 25N MLR supernatant, cytokines or CsA to MC or EnC, the expression of VCAM-1, ICAM-1, and alpha3beta1 and a501 integrins was examined by using cell surface enzyme immunoassays or flow cytometry. RESULTS: MLR supernatant induced a marked increase in the expression of ICAM-1 and VCAM-1 on MC or EnC(p<0.001). HC treatment during MLR effectively inhibited MLR-induced upregulation of VCAM-1 and ICAM-1 on both cells (p<0.005). HC had, however, no inhibitory effect on VCAM-1 expression when added with MLR supernatant to cells. CsA treatment during MLR caused a modest decrease in MLR-induced expression of VCAM-1 on EnC, but had no effect on that of ICAM-1. INFgamma or TGFbeta1 stimulated expression of VCAM-1, and INFgamma, IL-1beta, or TNF alpha expression of ICAM-1 on MC after 24 hr. INFgamma, or TGFbeta1 enhanced expression of alpha3beta1 or alpha5beta1 integrins on MC after 5 days. CsA caused a modest decrease in basal expression of VCAM-1, and also decreased the basal, or INFgamma, or TGFbeta1-induced expression of alpha3beta1 and alpha5beta1 integrins on MC. CONCLUSION: Alloreactive lymphocytes and monocytes upregulate expression of VCAM-1 and ICAM-1 on EnC and MC maybe by secretion of cytokines such as INFgamma, and facilitate leukocytes attachment and following renal or vascular injury. HC effectively prevent the upregulation of VCAM-1 and ICAM-1 by inhibiting the release of cytokines during MLR. CsA did not cause an increase in the expression of VCAM-1 and beta1 integrin.
Antigens, CD29 ; Cyclosporine* ; Cytokines ; Flow Cytometry ; Hydrocortisone* ; Immunoenzyme Techniques ; Integrins ; Intercellular Adhesion Molecule-1 ; Leukocytes ; Lymphocyte Culture Test, Mixed* ; Lymphocytes ; Mesangial Cells* ; Monocytes ; Up-Regulation ; Vascular Cell Adhesion Molecule-1 ; Vascular System Injuries

Single coronary artery is rare and the application of coronary angioplasty to these arteies presents unique technical challenge. As technical advances in the guiding catheter and balloon system occur, more challenging lesions including anomalous coronary artery are able to be treated. Correct guiding catheter selection is important to ensure adequate access to the anomalous vessel and provide support to cross the lesion. This report describes successful angioplasty with stent in right coronary artery of single ostium coronary anomaly in a patient presenting with an acute myocardial infaction.
Angioplasty ; Catheters ; Coronary Vessels* ; Humans ; Myocardial Infarction* ; Stents*