Hypertension is a risk factor for developing fatal aortic dissection. Aortic dissection occurs 2~3 times as often in men than in women between ages of 50~70 years old. Among other risk factors, aortic dissection occurs especially in women below the age of 40 years old in pregnancy-related cases. In pregnancy-related cases, aortic dissection occurs in the third trimester and in puerperium, as well as in multiparous women. The writers experienced an aortic dissection related pregnancy. The patient was 32 years old, diagnosis of dissection occurred in the postpartum period. Although, aortic dissection is a rare complication of pregnancy, the knowledge of this may assist the emergency physician save the lives of patients.
Adult ; Diagnosis ; Emergencies ; Female ; Humans ; Hypertension ; Male ; Postpartum Period ; Pregnancy ; Pregnancy Trimester, Third ; Risk Factors

No abstract available.
Ehlers-Danlos Syndrome*

OBJECTIVE: Recurrent herniation following disc excision has been reported in 5-15% of patients. There have been numerous studies of recurrent disc herniation, but these have analyzed mixed patient populations. We designed this study to analyze the factors that influencing the clinical results, and efficiency of repeat discectomy for recurrent lumbar disc herniation occurring at the same level and on the same side after primary discectomy. METHODS: Between 1990 and 2011, a total of 52 patients who underwent repeat discectomy for recurrent lumbar disc herniation were retrospectively analyzed. Clinical outcomes were measured with Macnab criteria and visual analog scale (VAS score). Clinical parameters were also analyzed for influencing factors for outcome. RESULTS: Based on Macnab criteria, an excellent surgical outcome was achieved in 28 cases (54%), a good outcome in 22 cases (42%), a fair outcome in 1 case (2%), and a poor outcome in 1 case (2%). Based on VAS score, 47 of 52 patients (90%) showed more than 4 score improvement. Age, sex, diabetes mellitus, smoking, time interval between repeat and primary discectomy, duration of recurrent symptoms, and extent of disc herniation did not significantly affect Macnab criteria and VAS score. However, a traumatic event showed less VAS score improvement whereas not affecting on Macnab criteria. CONCLUSION: Conventional open lumbar discectomy performed as repeat surgery for recurrent herniation showed satisfactory results. Based on the results of this study, repeat discectomy can be recommended for the management of recurrent lumbar disc herniation. Further study is needed to evaluate factors related to the outcomes of repeat discectomy.
Diabetes Mellitus ; Diskectomy ; Humans ; Reoperation ; Retrospective Studies ; Smoke ; Smoking

BACKGROUND: The stomach is the most common extra nodal site for non-Hodgkin's lymphoma: primary gastric lymphomas are uncommon, constituting only 1% to 5% of malignant gastric lesions. METHODS: To elucidate the clinicopathologic features of this lymphoma, we retrospectively analyzed 33 patients with primary gastric lymphoma who had been treated at our hospital from Jan. 1986 to Dec. 1995. RESULTS: Primary gastric lymphomas were 1.2% of all gastric cancers. The mean age 46 years (range 25 to 68 years). There were 23 men and 10 women. The most frequent chief complaint was epigastric pain. The most common location was the gastric antrum and body. According to the working formulation, the malignancy grades were 4 low, 26 intermediate, and 3 high. The overall 5-year survival rate was 60%. Survival of five years according to the TNM stage of the disease was as follows: stage 1, 88%; stage II, 71%; stage III, 33%; and stage IV, 29%. Patient with stage I, II disease had a 5-survival rate of 80% versus 35% for stage III, IV disease (p<0.05). Tumor serosal involvement and 5-year survival was follows: no perigastric serosal involvement, 93%; serosal infiltration, 33% (p=0.0016). In cases undergoing a subtotal gastrectomy, 5-year survival rate was 70%, whereas patients undergoing a total gastrectomy had a 5-year survival rate of 30% (p<0.05). Those with tumors smaller than 7 centimeters had a 5-year survival rate of 66% versus 38% for larger neoplasms (p=0.09). CONCLUSIONS: By univariate analysis, the stage, operation methods, and serosa involvement were significant prognostic factors. However, in multivariate analysis, only the serosa involvement was significant prognostic factor.
Female ; Gastrectomy ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Male ; Multivariate Analysis ; Pyloric Antrum ; Retrospective Studies ; Serous Membrane ; Stomach ; Stomach Neoplasms ; Survival Rate

There are some controversies on the mechanism of the lumbar disc degeneration and disc prolapse. But,it is clear that many factors are related to the disc degeneration. Configurations of the lower lumbar and lumbosacral spine have long been proposed as one of the important factors of disc degeneration in these areas. To look for the configurational risk factors and the probability of disc degeneration by the combinations of these factors, we analyzed simple radiographs and MRI of 73 patients who complaints of low back pain and are between 20 years and 39 years of age. We performed chi-square test and multivariate logistic regression analysis: L4-5 disc degeneration and L5-Sl disc degeneration as dependent variables and lumbar lordosis, sacral inclination, height of intercrest line, transitional vertebra and facet joint asymmetry as independent variables. We could not find any of these variables significantly related to the L4-5 intervertebral disc degeneration. For L5-S1 disc degeneration, only the presence of transitional vertebra was signicantly related. When there is no transitional vertebra, the probability of disc degeneration is 9 times(8.889) as large as that of presence of transitional vertebra. The probability of L4-5 disc degeneration without the degeneration of L5-S1 is 3 times as large as that of degeneration of both of L4-5 and L5-S1 disc in case of the presence of transitional vertebra.
Animals ; Humans ; Intervertebral Disc Degeneration* ; Logistic Models ; Lordosis ; Low Back Pain ; Magnetic Resonance Imaging ; Prolapse ; Risk Factors ; Spine* ; Zygapophyseal Joint

Mitochondrial encephalomyopathy with lactic acid and stroke-like episodes (MELAS) is a multisystem mitochondrial disorder that typically presents in childhood. We report a case of MELAS syndrome diagnosed in a 45-year-old man presented with chronic kidney disease before a stroke-like episode. Genetic testing revealed a m.3243A>G point mutation in the mtDNA. The original diagnostic criteria for MELAS required the onset of stroke-like episodes prior to 40 years of age but this case demonstrates that disease onset may delay in certain individuals.
DNA, Mitochondrial ; Genetic Testing ; Humans ; Lactic Acid ; Late Onset Disorders ; MELAS Syndrome* ; Middle Aged ; Mitochondrial Diseases ; Mitochondrial Encephalomyopathies ; Point Mutation ; Renal Insufficiency, Chronic* ; Stroke

Objective: Patients with post-traumatic stress disorder (PTSD) showed inconsistencies in their cortisol level, an index of the hypothalamic-pituitary-adrenal axis function. This study examined the relationship between dissociation, childhood trauma, and morning cortisol levels in PTSD patients. Methods: This study included 69 (23 males and 46 females) patients and 82 (22 males and 60 females) healthy controls (HCs). Clinical assessments, including the Childhood Trauma Questionnaire (CTQ) and Peri-traumatic Dissociative Experiences Questionnaire scores, and morning cortisol levels were evaluated. The morning cortisol levels were compared between PTSD with high dissociation and low dissociation (PTSD-LD) groups. The effect of CTQ subtype on morning cortisol levels was analyzed. Results: The PTSD with high dissociation group showed significantly lower cortisol levels than that of the PTSD-LD and HC groups. A significant inverse correlation was found between cortisol levels and dissociation. A significant positive correlation was found between dissociation and physical abuse and sexual abuse scores. Morning cortisol levels showed a significant positive correlation with emotional abuse, emotional neglect, and physical neglect, respectively. There was no moderating or mediating effect of CTQ on the relationship between cortisol level and dissociation. Conclusion These findings suggest that dissociation is a significant factor related to hypocortisolism in PTSD patients.Additionally, basal morning cortisol levels and dissociation scores were closely associated with childhood trauma.

Background: Multiple Allergo-Sorbent Test (MAST) allows simultaneous detection of specific IgE antibodies using multiple allergens, and it is commonly used for allergy screening. Phadiatop assay (Phadia AB, Sweden), including Phadiatop test and Phadiatop Infant test, is a variant of specific IgE test that covers a mixture of common allergens. We compared the clinical utility of Phadiatop assay with that of the MAST AlloScreen (LG Life Science, Korea). Methods: A total of 218 samples classified by AlloScreen results were collected. Phadiatop test was performed on sera from 61 and 103 aeroallergen-positive and -negative subjects. Phadiatop Infant test was performed on sera from 54 and 103 food and aeroallergen-positive and -negative subjects. When the results of AlloScreen and Phadiatop assay were not identical, we confirmed them using ImmunoCAP (Phadia AB). Results: The concordance rate between AlloScreen and Phadiatop test was 93.2% (κ=0.86, P<0.001). Eleven (6.7%) of 164 specimens showed discrepant results. The results of AlloScreen did not agree with those of ImmunoCAP. The concordance rate between AlloScreen and Phadiatop Infant test was 97.4% (κ=0.945, P <0.001). Four (2.5%) specimens showed negative results in AlloScreen and positive results in Phadiatop Infant test. Three cases were confirmed as positive and one case was not confirmed through ImmunoCAP. Conclusions There was excellent agreement between AlloScreen and Phadiatop assay. Phadiatop assay accurately detected sensitization to common food and aeroallergen mixes. Therefore, Phadiatop assay is recommended as a screening test for allergic diseases.