Upper gastrointestinal(UGI) bleeding was critical disease that was commonly found in emergency department and needed more early diagnosis and rapid treatment for decreasing mortality and morbidity. It's causes and frequencies here affected by many factors, but the majorities were caused by peptic ulcers and esophageal-gastric varices. With development of economy and medical services, new drugs and endoscopic interventions, the treatment of patients with UGI bleeding was more improved. So I would like to evaluate the change of causes and frequencies of UGI bleeding and the associated clinical findings. A total of 1,546 patients presented with UGI bleeding in emergency department of Yeungnam university hospital during the five years from Jan. 1991 to Dec. 1995 were clinically reviewed by charts and compared with previous seven years report from Jan. 1984 to Dec. 1990 in the same hospital. The ratio of male to female was 6.1:1 and slightly increased in comparison with previous seven years. The incidences in 6th and 5th decades were highest(54.4%) as like as previous seven years. Age distribution of duodenal ulcer bleeding, Mallory-Weiss tear and acute gastric mucosal lesion were developed in lower decades than the others. The causes of UGI bleeding were caused by esophageal varix(45.4%), peptic ulcer(38.8%), Mallory-Weiss tear(4.3%), gastric cancer(3.8%), others(3.1%), acute gastric mucosal lesion(2.7%), undetermined causes(1.8%) in defending order of frequencies. The proportion of esophageal varices was increased from 36.6% to 45.4%, but that of peptic ulcer was relatively decreased from 47.6% to 38.8%. And the annual distribution of varices was increased, however the annual distribution of peptic ulcers was increased. Although the ranking of annual distribution of gastric ulcers and duodenal ulcers were not changed compared to previous study and the frequency of gastric ulcers was increased since 1992, but additional follow-up was needed. Seasonal variations were found that upper gastrointestinal bleeding was increased in fall and peptic ulcer bleeding was increased significantly in summer and fall, however, varix bleeding was less frequent in summer time as like as previous seven years. Emergency endoscopic examination was performed within 6 hours far 54.5%, 24 hours for 90.8% and this reacts were to be like previous results, 57.5% and 90.7% respectively. Findings of emergency endoscopic examination were active bleeding focus(21.2%), blood clot(7.9%), exposed vessels(13.3%), flat blood spot(6.4%) and lesion without evidence of bleeding(51.3%). Endoscopic findings of active bleeding were easily seton when examination was perfomed within 24 hours. Blood transfusion was performed in 67.3% with average 2.1 units. When the causes of bleeding were due to varix and marginal ulcer, more amounts of blood were transfused than the others. In previous seven years, blood transfusions were performed in 71.2% with average 5 units and more amounts of blood were transfused in gastric cancer and varix bleeding.
Age Distribution ; Blood Transfusion ; Duodenal Ulcer ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Esophageal and Gastric Varices ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Male ; Mallory-Weiss Syndrome ; Mortality ; Peptic Ulcer ; Seasons ; Stomach Neoplasms ; Stomach Ulcer ; Varicose Veins

With the purpose of clarifying the etiology and its characteristics of PCA infarction, we analyzed 60 consecutive patients with cerebral infarction involving occipital-or inferior temporal lobes. To elucidate the underlying causes of PCA infarcts, we reviewed medical records for clinical and laboratory risk factors, neuroimaging studies, echocardiog.ram, and angiographic findings. The com non causes of PCA infarcts were thrombotic, embolic, unknown, and miscellaneous causes in decreasing order. The most common symptom was hemianopsia or cortical blindness. Sensorimotor symptoms were present in 36 patients and confusion in 16 patients. Confusion was closely correlated with old age or infarcts outside the PCA territory(p<0.05). The patients of either thrombotic or embolic infarcts were older than those of miscellaneous or unknown causes(p<0.05). Bilateral occlusions were less common in thrombotic and embolic infarct in comparison with miscellaneous causes. Atrial fibrillation or sick sinus syndrome were the usual causes of embolic infarct. In miscellaneous causes of infarct, migraine were in four patients. Clinical outcome was better in unknown causes than in thrombotic or miscellaneous causes of infarct (p<0.05). These findings revealed that thrombosis was a worse prognostic factor than embolism as well as a leading cause of PCA infarct.
Atrial Fibrillation ; Blindness, Cortical ; Cerebral Infarction ; Embolism ; Hemianopsia ; Humans ; Infarction, Posterior Cerebral Artery* ; Medical Records ; Migraine Disorders ; Neuroimaging ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Risk Factors ; Sick Sinus Syndrome ; Temporal Lobe ; Thrombosis

Iron-induced oxidative stress has been emphasized in the pathomechanism of Parkinson's disease (PD). Studies on the distribution of iron in the parkinsonian postmortem brain have demonstrated that iron deposition is selectively increased in substantia nigra pars compacta (SNc). This study was done to examine the alteration of nigral iron and ferritin in an animal model of parkinsonism and to understand the role of disturbed iron metabolism as a cause of PD. Hemiparkinsonian model was made by stereotaxically injecting 6-OHDA into the SN of Sprague-Dawley rats. We measured the content and distribution of iron by Perls' staining, and ferritin by immunohistochemical method in the SN. The H & E. cresyl violet, and immunocytochemical stain for glial fibrillary acidic protein, tomato lectin, and cabonic anhydrase-II were done to characterize the exact cell types. Iron content was markedly increased in the hemiparkinsonian model of SNc, not reticulate where normally more iron is distributed. The increased ferritin immunoreactivity was located in the same iron rich area of SNc. The cells with increased iron and ferritin were mainly astrocytes and microglias. 6-OHDA injection into SN resulted in increased free iron and ferritin immunoreactivity, suggesting that iron is important participant in oxidative cell death in PD. We think that increased ferritin in 6 OHDA lesioned SN argues against the hypothesis that decreased ferritin is a prerequisite for the free radical mediated death of nigral neurons in this model.
Animals ; Astrocytes ; Brain ; Cell Death ; Ferritins* ; Glial Fibrillary Acidic Protein ; Iron* ; Lycopersicon esculentum ; Metabolism ; Microglia ; Models, Animal ; Neurons ; Oxidative Stress ; Oxidopamine* ; Parkinson Disease ; Parkinsonian Disorders ; Rats* ; Rats, Sprague-Dawley ; Substantia Nigra ; Viola

Authors reviewed 28 cases of displaced acetabular fracture treated operatively from Februay 1991 to January 1996 and followed up more than 1 year. The clinical results were retrospectively analyzed with consideration of surgical problems and complications. The results were as follows; 1. According to Letournels classification, we had 16 elementary fractures(57%) and 12 associated fractures(43%). 2. Kocher-Langenbeck approach in 16 cases, ilioinguinal in 9 cases, extended iliofemoral 2 cases and combined approach in 1 case were used. 3. The devices for internal fixation were as follows: screw only in 12 cases(elementary fracture 9cases, associated fracture 3 cases), plate and screw in 16 cases(elementary fracture 7 cases, as-sociated fracture 9 cases). 4. There were complications such as 3 degenerative arthritis, 2 superficial wound infection, 1 iatrog-enic sciatic nerve palsy and 1 avascular necrosis of femoral head and no postoperative heterotro-phic ossification. 5. Satisfactory reduction by radiologic criteria was gained in 23 cases(82%). Satisfactory results by clinical criteria(by dAubigne & Postels) was gained in 21 cases(75%). Only 2 patient with a satisfactory radiologic reduction was clinically unsatisfactory. It seems that the satisfactory operative reduction of the fracture is the factor that correlates best with a satisfact-ory clinical result.
Acetabulum* ; Classification ; Head ; Humans ; Necrosis ; Osteoarthritis ; Retrospective Studies ; Sciatic Neuropathy ; Wound Infection

Interferon(IFN) has been noted to augment the cytotoxicity of cisplatin analogues and S-FU, and varying degrees of success were reported when combined with chemotherapy in a number of squamous cell carcinomas. The aims of this study were to assess its therapeutic efficacy and to establish the feasibility and toxicity of biochemical modulation of the interferon-a-2a when combined with 5-FU and carboplatin(CBDCA) in locally advanced(> or =FIGO clinical stage IJb) and/or bulky(largest diameter > or = 3cm) cervical cancer. From January 1995 to December 1996, 20 patients with bulky and/or locally advanced cervical cancer were enrolled in this study and received FAC(5-FU/Interferon-a/CBDCA) combination chemotherapy as a neoadjuvant setting. The FAC regimen was composed of IFN- a -2a 3x10(6) IU/day from day l to day 6, 5-FU 750mg/m2/day from day 2 to day 6, and carboplatin at a dose calculated by Calvert formula with AUC(area under the curve) 6.0 on day 2. Three cycles of neoadjuvant chemotherapy was performed with 3 weeks interval if toxicity permitted it. Patients were examined after every treatment cycle and evaluated for toxicities and responses using standard GOG criteria. Two patients(10.0%) showed complete clinical response and 15 patients(75,0%) had partial response. The other patients had stable(10.0%) or progressive disease(5.0%). Among fifteen patients who have undergone radical hysterectomy, pathological complete response was not noted. Surgery was possible in 15 patients(75.0%) and 10 patients received adjuvant radiotherapy. Lymph node metastases were found in 5 patients(33.3%) and the number of positive nodes was ranged from 1 to 5. The most frequent grade 3 or 4 toxicity was neutropenia(60.0%) followed by alopecia(40.0%), nausea/vomiting(35.0%), thrombocytopenia(15.0%), diarrhea(5.0%), and anemia(5.0%). (continue)
Carboplatin ; Carcinoma, Squamous Cell ; Cisplatin ; Drug Therapy* ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Uterine Cervical Neoplasms

No abstract available.
Emergencies ; Humans

No abstract available.
Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans

The experienced surgeon can be surprised & challenged by the hazards of active bleeding during oral & maxillofacial surgical procedure, because of alterations in the surgical anatomy, bleeding disorders and surgical intervention of infected tissues. This is a report of two cases of active bleeding during surgical extraction of mandibular third molar, that had the pericoronitis, osteitis and adjacent neurovascular bundle in its apex. When the abrupt active bleeding was occurred during surgical extraction of mandibular third molar, pressure packing by hemostatic agent(bone wax) & wet gauze biting were applied into the extraction socket during 30 minutes. After 30 minutes, the wound was explored about the bleeding and active bleeding was then continued. In spite of repeated bleeding control method of the pressure dressing, the marked hemorrhage was generated continuously. Therefore, the author decised the bleeding as immediately uncontrollable hemorrhage and the pressure dressing was again applied for the more longer duration without wound closure. After 3 days, the pressure dressing was removed and iodoform gauze drainge was then established without the bleeding. The drain was changed as the interval of 3~5 days for prevention of infection & secondary hemorrhage and relatively good wound healing was then resulted in 6 weeks.
Bandages ; Hemorrhage* ; Molar, Third* ; Osteitis ; Pericoronitis ; Wound Healing ; Wounds and Injuries

Superficial siderosis is a rare condition characterized by hemosiderin deposition in leptomeninges, subpial tissue, brainstem, cerebellum, spinal cord, and cranial nerves. Slowly progressive hearing loss and gait ataxia are invariable clinical manifestations. We report three patients with their clinical and radiological features. All patients presented with hearing loss and cognitive dysfunction. Two showed gait ataxia and myelopathic symptoms and signs. Decreased visual acuity, hand tremor, limb ataxia, dysarthria, and nystagmus were also present. All patients showed typical MRI findings: marked linear hypointensities around the cerebellum, brainstem, and the surface of the cerebral cortex, especially in sylvian fissures. Two patients had brain tumors : pituitary adenoma and oligodendroglioma. Another patient had no definite bleeding source. Hemosiderin deposition is caused by chronic and recurrent subarachnoid hemorrhage derived from tumor, vascular malformation, aneurysm, posthemispherectomy, and unknown bleeding sources. Diagnosis is easily made by characteristic clinical manifestations and MRI findings. The selective vulnerability of the cerebellum and the 8th cranial nerve depends upon their own histological and biochemical characteristics. Benefits of the iron chelating agents are questionable. Removal of the possible bleeding sources is the most reliable strategy to prevent the disease progression.
Adenoma ; Aneurysm ; Ataxia ; Brain Neoplasms ; Brain Stem ; Cerebellum ; Cerebral Cortex ; Cranial Nerves ; Diagnosis ; Disease Progression ; Dysarthria ; Gait Ataxia ; Hand ; Hearing Loss ; Hemorrhage ; Hemosiderin ; Humans ; Iron Chelating Agents ; Magnetic Resonance Imaging ; Oligodendroglioma ; Pituitary Neoplasms ; Siderosis* ; Spinal Cord ; Subarachnoid Hemorrhage ; Tremor ; Vascular Malformations ; Visual Acuity

Status epilepticus (SE) is a neurological emergency that requires prompt diagnosis and treatment. Prognosis of SE depends mostly on the underlying illnesses and secondary brain damage from seizure activity. For early detection of poor prognostic factors in SE, we retrospectively analyzed 121 SE patients with their medical redords, laboratory findings, and neuroimaging studies. No single factor other than the previous history of seizure was associated with their prognosis. According to presence or absence of previous seizure history, they were divided into the first-ever seizure group (53 patients) and recurrent seizure group (68 patients). We compared both two groups in respect to demographic, neurological, and radiological features, response to antiepileptic drugs (AEDs), and short-term outcome of SE. The results stggest that the patients of the first-seizure group are older and have more frequent detectable etiological diseases, poor response to AEDs, and higher mortality, hence prognosis being worse than the recurrent-seizure group.
Anticonvulsants ; Brain ; Diagnosis ; Emergencies ; Humans ; Mortality ; Neuroimaging ; Prognosis ; Retrospective Studies ; Seizures* ; Status Epilepticus*