OBJECTIVE: The goal of this study was to review the etiologies, phathophysiology, clinical presentations and to compare the results of the surgical methods of subdural empyema especially in infants. PATIENTS AND METHODS: We reviewed the clinical data of five infantile subdural empyemas experienced in our hospital from 1993 to 1998 which were all surgically treated by craniotomy or burr hole trephination. We experienced five cases of infantile subdural empyema: two males and three females. The ages ranged from 40 days to 11 months. RESULTS: The etiologies of all five cases were unproven but all five cases had meningitis before the subdural empyemas were diagnosed. The causative organism in one was streptococcus pneumoniae, and the other were unknown. Two were treated with craniotomy(one with a good outcome and the other died) and three were treated with burr hole trephination(all three had a good outcome). CONCLUSION: Subdural empyema is a rapid progressing disease and it is important to detect and treat in the early stages of disease. The choice of surgical method must be based on the stage of the disease and its location in the cranial cavity.
Craniotomy ; Empyema, Subdural* ; Female ; Humans ; Infant* ; Male ; Meningitis ; Streptococcus pneumoniae ; Trephining

PURPOSE: To compare the effects of various serotonergic drugs on the inhibition of intraluminal pressure rise in the rat vas deferens induced by electrical stimulation of the hypogastric nerve. MATERIAL AND METHODS: Twenty-five Sprague Dawley rats (250-300 gm) were randomly divided into five groups of five animals each, which received intravenous injection of normal saline, clomipramine, sertraline, paroxetine, or fluoxetine. Before (baseline pressure) and 30 minutes after intravenous injection of four different doses (0.1 to 20 the therapeutic dose) of each agent, the hypogastric nerve, identified using microsurgical technique, was electrically stimulated, and the intraluminal pressure of the vas deferens was measured (central effect group). To evaluate the peripheral effects of clomipramine and sertraline, intraluminal vasal pressure was also measured after transection of all proximal sympathetic nerves projecting to the hypogastric nerve and the commissural branches between the right and left major and accessory pelvic ganglia. The adrenal veins were ligated bilaterally. RESULTS: Repeated stimulation of the hypogastric nerves, anesthesia of long duration (3hours), and repeated intravenous injection of normal saline did not result in significant changes in the intraluminal pressure of the vas deferens in a dose-dependent manner (p<0.05). The extent of inhibition by 20-fold therapeutic doses of clomipramine, sertraline, paroxetine, and fluoxetin were 74.4 1.8%, 34.1 8.3%, 24.8 7.8%, and 8.1 3.5%, respectively. At doses 10- and 20-fold the therapeutic dose, clomipramine had the strongest inhibitory effect, followed by sertraline and paroxetin, then fluoxetine (p<0.05). Definite inhibition was noted in all rats receiving clomipramine at 10- and 20-fold the therapeutic dose; the degree of inhibition was 80% in the sertraline-, 60% in the paroxetine-, and 20% in the fluoxetin-treated group. The inhibitory effect of sertraline on the elevation of the intraluminal vasal pressure in the peripheral-effect group was significantly (p<0.01) less than that in the central-effect group. However, there was no difference in the inhibitory effect of clomipramine in the two groups. CONCLUSIONS: Clomipramine was the most potent inhibitor of the elevation of the intraluminal pressure of the rat vas after electrical stimulation of the hypogastric nerve. The greater effect might be attributable to an additional peripheral effect of this drug on the vas deferens.
Anesthesia ; Animals ; Clomipramine ; Electric Stimulation* ; Fluoxetine ; Ganglia ; Injections, Intravenous ; Paroxetine ; Rats* ; Rats, Sprague-Dawley ; Serotonin Agents* ; Sertraline ; Vas Deferens* ; Veins

PURPOSE: To clarify the short-term effect and long-term results of bronchial arterial embolization forhemoptysis in three groups with tuberculosis, idiopathic bronchiectasis and lung cancer. MATERIALS AND METHODS:This study invo l ved 54 patients who underwent arterial embolization for the control of hemoptysis. Among 54, thecauses of hemorrhage were; pulmonary tuberculosis(n=32), idiopathic bronchiectasis (n=15), and lung cancer(n=7).In all patients, em-bolization was performed using Gelfoam particles and three underwent additional coilemboliza-tion. After the procedure, patients were followed up for between 1 and 95 (mean, 36.7) months. Short-termresults were assessed on the basis of careful observation of patients for 1 month after ar-terial embolization andwere classified as either; successful, indicating complete cessation of he-moptysis for 1 month, or failed,indicating continuing hemoptysis or recurrence within 1 month. Long-term results were evaluated in patients inwhom the procedure was successful in the short term and who could be followed up for at least 6 months. Patientsshowed either complete remis-sion(CR), indicating complete cessation of bleeding during the observation period;partial remis-sion(PR), indicating complete cessation of hemoptysis with recurrent bloody sputum during theobservation period; or recurrence, indicating recurrent hemoptysis, and were grouped accordingly. RESULTS: Noserious procedure related complications occurred except for mild chest pain or fever, of which showed spontaneousrelief within a few day s. The overall short-term success rate was 7 9 .6 %(43/54); individual rates were 84.4%for pulmonary tuberculosis (27/32), 80% for idiopathic bronchiectasis (10/15), and 57.1 % for lung cancer (4/7).Long-term follow-up showed that complete remission was achieved in 24 of 43 cases (55.8 %).The respectivelong-term remission and recur-rence rates were 75 % and 25 % for bronchiectasis, 70.4 % and 29.6 % for pulmonarytuberculosis. While four lung cancer patients whose initial outcome was successful showed no recurrence ofhe-moptysis, three died within 3 months of embolization. CONCLUSION: Embolization of bronchial arteries using aGelfoam sponge is effective as initial treat-ment for moderate or severe hemoptysis caused by benign disease.During long-term follow up, high remission rates were achieved in pulmonary tuberculosis and idiopathicbronchiectasis pa-tients, while the shortest bleeding control was in cases involving lung malignancy.
Bronchial Arteries ; Bronchiectasis ; Chest Pain ; Fever ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hemoptysis* ; Hemorrhage ; Humans ; Lung ; Lung Neoplasms ; Porifera ; Recurrence ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: This study was conducted to examine if basal luteinizing hormone (LH) levels could be useful for screening central precocious puberty (CPP) in girls. METHODS: A total of 90 girls under the age of 8 years were included in this study. They underwent the gonadotropin-releasing hormone (GnRH) stimulation test at Good Gang-An Hospital from March 2008 to December 2012 for evaluation of premature sexual development. Patients were classified into two groups: the pubertal response group of patients who had 5 IU/L peak LH levels in the GnRH stimulation test, and the prepubertal response group of patients who had LH levels <5 IU/L. Chronological and bone ages, height, weight, body mass index, gonadotropin response to GnRH stimulation, and basal levels of LH, follicle-stimulating hormone, and estradiol were studied in both groups. The relationship between basal LH and peak-stimulated LH was evaluated using Spearman's correlation. To determine the optimal cut-off values of basal LH levels for differentiating between two groups, the receiver operating characteristic (ROC) curves were analyzed. RESULTS: When the correlation between basal LH levels and peak LH after GnRH stimulation was analyzed in all subjects (N=90), basal LH levels had a statistically significant positive correlation with peak stimulated LH levels (rs=0.493, p<0.001). The cut-off level of optimal basal LH was 0.1 IU/L, according to the ROC curves. Its sensitivity was 73.3%, and its specificity was 77.8%. CONCLUSION: The study results showed that serum basal LH levels are useful for screening CPP in girls.
Body Weight ; Estradiol ; Female* ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Lutein* ; Luteinizing Hormone* ; Mass Screening* ; Puberty, Precocious* ; ROC Curve ; Sexual Development

BACKGROUND: This study was conducted to examine if basal luteinizing hormone (LH) levels could be useful for screening central precocious puberty (CPP) in girls. METHODS: A total of 90 girls under the age of 8 years were included in this study. They underwent the gonadotropin-releasing hormone (GnRH) stimulation test at Good Gang-An Hospital from March 2008 to December 2012 for evaluation of premature sexual development. Patients were classified into two groups: the pubertal response group of patients who had 5 IU/L peak LH levels in the GnRH stimulation test, and the prepubertal response group of patients who had LH levels <5 IU/L. Chronological and bone ages, height, weight, body mass index, gonadotropin response to GnRH stimulation, and basal levels of LH, follicle-stimulating hormone, and estradiol were studied in both groups. The relationship between basal LH and peak-stimulated LH was evaluated using Spearman's correlation. To determine the optimal cut-off values of basal LH levels for differentiating between two groups, the receiver operating characteristic (ROC) curves were analyzed. RESULTS: When the correlation between basal LH levels and peak LH after GnRH stimulation was analyzed in all subjects (N=90), basal LH levels had a statistically significant positive correlation with peak stimulated LH levels (rs=0.493, p<0.001). The cut-off level of optimal basal LH was 0.1 IU/L, according to the ROC curves. Its sensitivity was 73.3%, and its specificity was 77.8%. CONCLUSION: The study results showed that serum basal LH levels are useful for screening CPP in girls.
Body Weight ; Estradiol ; Female* ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Lutein* ; Luteinizing Hormone* ; Mass Screening* ; Puberty, Precocious* ; ROC Curve ; Sexual Development

A 38-year-old woman presented with massive hemoptysis ( 200 mL/ 24 hours) occurring abruptly after generalized tonic clonic seizure. She experienced similar episodes of hemoptysis on three later occasions. Although the coexistence of hemoptysis and seizure has been reported, albeit rarely, as a clinical manifestation of postictal neurogenic pulmonary edema, massive hemoptysis after seizure is an extremely rare event with no recurrent cases of such episodes having ever been reported. The coexistence of hemoptysis and seizure increases the difficulty in diagnosis for the clinician. We describe the differential diagnosis among the diseases capable of causing seizure and hemoptysis.
Adult ; Case Report ; Diagnosis, Differential ; Epilepsy, Tonic-Clonic/*complications ; Female ; Hemoptysis/*diagnosis/etiology ; Human ; Pulmonary Alveoli ; Pulmonary Edema/complications ; Recurrence ; *Respiration, Artificial

BACKGROUND: Plasmodium vivax malaria is an acute debilitating illness characterized by recurrent paroxysmal fever and relapses from hypnozoites in the liver. Although a few studies reported clinical characteristics of vivax malaria in civilians after reemergence in the Republic of Korea, only a small group of patients was analyzed. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had been diagnosed with vivax malaria by peripheral blood smear in a university-affiliated hospital located in a malaria-endemic area between January 2005 and December 2009. RESULTS: During the study period, a total of 352 malarial cases from 341 patients were diagnosed. Vivax malaria was most commonly developed in July and August, 24.7% (87/352), and 21.9% (77/352), respectively. The mean (SD) age was 42.5 (14.7) years and the number of male patients was 243 (71.3%). Six patients had a previous history of vivax malaria from 6 months to 10 years before. A total of 337 patients (98.8%) had fever and the mean (SD) body temperature was 38.3 (1.4)degrees C. Common associated symptoms were chills (213/341, 62.5%), headache (115/341, 33.7%), and myalgia (85/341, 24.9%). Laboratory findings included thrombocytopenia (340/341, 99.7%), anemia (97/341, 28.5%), leukopenia (148/341, 43.4%), increase of aspartate transaminase (177/341, 51.9%), and increase of alanine transaminase (187/341, 54.8%). Hypotension (14/341, 4.1%), altered mentality (3/341, 0.9%), azotemia (3/341, 0.9%), spleen infarction (2/341, 0.6%), and spleen rupture (1/341, 0.3%) developed as complications. Chloroquine was administered to all patients and primaquine was administered with mean (SD) 3.39 (0.82) mg/kg to 320 patients. There were 11 recurrent infections during the study period. The median (range) time to recurrent infection was 100 (32-285) days. Platelet counts were higher (86,550 vs. 56,910/mm3) and time to treatment of malaria was shorter (5 vs. 7 days) in relapsed cases compared with first occurrence cases (P=0.046). CONCLUSIONS: The overall recurrence rate of vivax malaria was 3.2% (11/341) in this study. In recurred cases, malaria was diagnosed earlier and thrombocytopenia was less severe. To evaluate the risk factors associated with recurrence and adequate dose of primaquine in Korean patients, further large-scale prospective studies will be needed.
Alanine Transaminase ; Anemia ; Aspartate Aminotransferases ; Azotemia ; Body Temperature ; Chills ; Chloroquine ; Fever ; Headache ; Humans ; Hypotension ; Infarction ; Leukopenia ; Liver ; Malaria ; Malaria, Vivax ; Male ; Medical Records ; Platelet Count ; Primaquine ; Recurrence ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Rupture ; Spleen ; Thrombocytopenia ; Time-to-Treatment

Purpose: This study aimed to evaluate and compare the accuracy of the size of the posterior malleolar fragment measured using lateral plain radiography and three-dimensional computed tomography (3DCT) in patients with ankle trimalleolar fractures. Materials and Methods: This study enrolled 80 patients (80 ankles) with ankle trimalleolar fractures and analyzed the size of the posterior malleolar fragments using plain radiography and 3D-CT. The articular involvement of the posterior malleolar fragments was measured as a percentage of the articular surface in the sagittal length of the tibial plafond using lateral plain radiography, and the articular surface area was directly measured using 3D-CT. In addition, we classified the patients into three groups based on the morphology of the posterior malleolar fracture, according to the Haraguchi classification method, and evaluated and compared the accuracy of the size of the posterior malleolar fragments. Results: The mean articular involvement of the posterior malleolar fragments on plain radiography was 27.6% (range, 6.0%-53.1%), which was significantly higher than the mean of 21.9% (range, 4.7%-47.1%) measured using 3D-CT (p=0.004). In the analysis, according to the fracture morphology, the mean difference between the two methods was the largest for type I fractures at 9.1% (range, 1.8%-19.5%) and the smallest for type II fractures at 1.1% (range, –7.7% to 8.8%). Conclusion The articular involvement of posterior malleolar fragments measured using plain radiography showed low accuracy and significantly higher values than the actual articular involvement. Therefore, careful evaluation using 3D-CT is crucial for accurate analysis and optimal treatment in patients with ankle trimalleolar fractures.

In patients with situs inversus totalis, the superior vena cava is normally positioned on the left side and drains into a left-sided right atrium (RA). If right-side superior vena cava (RSVC) is also present, it should be thought of as a combined congenital anomaly. Here, we report a case of successful pacemaker lead insertion through the RSVC in a patient with situs inversus totalis. The left-side superior vena cava (LSVC) had been already used as a route for the first pacemaker lead insertion 15 years earlier. During the pacemaker lead revision, we found that the LSVC was obliterated, and used the RSVC as a route for a new pacemaker lead insertion.
Heart Atria ; Humans ; Pacemaker, Artificial ; Situs Inversus ; Vena Cava, Superior

The purpose of this study was to investigate the fluoroquinolone resistance frequency of Enterococcus spp. from normal chicken feces and to analyse mutations of the gyrA and parC gene associated with fluoroquinolone resistance. Among 52 Enterococcus faecalis and 25 E. faecium isolates, 23 (44.2%) E. faecalis and 7 (28.0%) E. faecium were resistant to ciprofloxacin (CIP) by disc diffusion method. Genetic exchange in gyrA and parC gene among 2 CIP intermediate isolates and 15 CIP resistant isolates were found in the amino acid codon of Ser-83 and Asp-87, and Ser-80 and Glu-84, respectively. These mutants contained a change from Ser to Phe, Val, Tyr, Ile, Thr or Pro at codon 83 and from Glu to Gly or Leu at codon 87 in gyrA gene, and a change from Ser to Ile or Thr at codon 80 and from Glu to Asp or Lys at codon 84 in parC gene. The isolates with mutation in gyrA regardless of a mutation in parC showed high resistance (MIC > or =32 microgram/ml) to CIP, enrofloxacin, norfloxacin and ofloxacin. These results suggested that gyrA gene is the primary target for 4 fluoroquinolones resistance in Enterococcus spp.
Chickens* ; Ciprofloxacin ; Codon ; Diffusion ; Enterococcus faecalis ; Enterococcus* ; Feces* ; Fluoroquinolones ; Norfloxacin ; Ofloxacin ; Viperidae