No abstract available.
Aged* ; Humans ; Pneumonia*

No abstract available.
Aged* ; Humans ; Pneumonia*

PURPOSE: We report seven cases of pancreas transplantation, first performed in Korea, in the context of postsurgical radiologic studies. MATERIALS AND METHODS: All patients with insulin-dependent diabetes mellitus received transplants from cadevaric(n=6) or living related donor(n=1). Retrospective analysis of 27 US(including 19 Duplex US), two CT, four MRi, and three scintigraphy for these patients was made with surgico-pathological correlation in five cases. RESULT:Of the seven patients, three-month graft survival was five and one-year survival was two. One patient died of abdominal abscess following surgery. US gave the valuable informations regarding the graff swelling, vascular complication, and perigraff fluid collection. RBC bleeding scan was effective of the presence or absence and location of intestinal bleeding. CT was useful in determining the extent and severity of the pancreatitis. MRI gave a little information about functional status of the grafted pancreas. CONCLUSION: The choice of appropriate imaging modalities for postsurgical work up in patients who had pacreas transplantation depends on the clinical conditions of the patients and complications suspected. Further prospective studies appear to be necessary to eatablish the interval and modality choice for early detection of the complication.
Abdominal Abscess ; Diabetes Mellitus, Type 1 ; Graft Survival ; Hemorrhage ; Humans ; Korea ; Magnetic Resonance Imaging ; Pancreas Transplantation* ; Pancreas* ; Pancreatitis ; Radionuclide Imaging ; Retrospective Studies ; Transplants

PURPOSE: It may be difficult to differentiate renal cell carcinoma involving collecting system from renal urothelial tumor invading into renal parenchyma. The purpose of this study was to assess the differences of CT findings between two conditions. MATERIALS AND METHODS: CT findings of 5 cases of renal cell carcinoma involving the renal collecting systems and 10 cases of renal urothelial tumors invading the renal parenchyma were compared, and analyzed about the presence or absence of hydronephrosis, normal or abnormal CT nephrogram, renal contour changes due to mass and tentative diagnosis. The diagnoses were confirmed at surgery. RESULTS: Renal cell carcinoma showed hydronephrosis in only 20% and normal CT nephrogram and outward contour bulging in all cases. In contrast, renal urothelial tumor showed hydronephrosis(70%), abnormal CT nephrogram(60%), and preservation of reniform shape(100%). CONCLUSION: Renal contour changes and CT nephrogram may be useful in distinguishing both disease entities.
Carcinoma, Renal Cell* ; Diagnosis ; Hydronephrosis

The diagnostic value of nerve conduction study of spinal stenosis is far limited due to its deeply located lesion and its very short length of diseased nerve compared to the relatively long length of total conduction distance. Recently it became possible to stimulate the deep sited spinal nerve roots non-invasively with magnetic stimulation. The authors made a new method to calculate the motor nerve conduction time of lumbar spinal root using magnetic stimulation and planned to verify the delayed conduction time in patients with spinal stenosis who didn't show any abnormalities in the conventional electrophysiologic studies(peripheral nerve conduction velocity, F-wave and needle EMG). Three steps of magnetic stimulation were applied to vertex(transcortical stimulation), T12 spinous process(thoracic stimulation) and S1 spinous process(sacral stimulation), and three channel recording were performed at rectus abdominis(RA), right and left abductor hallucis(AH) simultaneously. Central motor conduction time(CMCT) was calculated by time difference between vertex and spinal stimulation at RA and AH. Lumbar-segment motor conduction time(LMCT) was defined as conduction time by subtracting CMCT of RA from CMCT of AH. The results as follows; LMCT was delayed in the group of patients with spinal stenosis(5.36+/-2.11 msec) compared to the normal control group(4.05+/-1.23 msec), but the range of LMCT was not quite different individually. Dividing the patients group into multi-level and single-level spinal stenosis group, LMCT in the multi-level spinal stenosis group was 6.12+/-1.95 msec which was significantly different from that of single-level(4.48+/-1.96 msec). The authors conclude that LMCT, the short segmental motor nerve conduction study of lumbosacral nerve root, is useful to confirm the entrapment of spinal nerve root across the lumbosacral spinal canal and is also non- invasive, simple and applicable to any other spinal nerve roots.
Evoked Potentials, Motor ; Humans ; Needles ; Neural Conduction* ; Spinal Canal ; Spinal Nerve Roots ; Spinal Stenosis*

OBJECTIVE: To evaluate the clinical utility of the dynamic gastrocnemius length, calculated with gait analysis after phenol or botulinum toxin block in spastic cerebral palsy. METHOD: Gastrocnemius muscles were injected with phenol or botulinum toxin. Kinematic gait parameters including dynamic gastrocnemius length were surveyed with 3-dimensional gait analysis system before and after the procedure. RESULTS: The dynamic gastrocnemius lengths improved significantly after block of calf muscles, except 3 cases which showed severe genu recurvatum. The vertical displacement of the center of gravities and the maximal ankle dorsiflexion angles after the block were not significantly different from those before the block. CONCLUSION: Dynamic gastrocnemius length calculated with gait analysis can be used as a tool to determine the efficacy of spastic calf muscle block, in the absence of severe genu recurvatum. In case of associated severe genu recurvatum, other parameters may be substituted.
Ankle ; Botulinum Toxins ; Cerebral Palsy* ; Gait ; Gravitation ; Muscle Spasticity* ; Muscle, Skeletal* ; Muscles ; Phenol

BACKGROUND: Status epilepticus (SE) shows stereotyped progression of electroencephalogram (EEG) and behaviors in human and some SE models. We analysed semiologic features with the electroencephalographic characteristics of kainic acid (KA)-induced SE which showed different patterns from the previously reported patterns of SE. METHODS: Seventeen male Sprague-Dawley rats weighing 150~220 grams were used. SE was induced 5~7 days after the place-ment of epidural electrodes on the rats, using 13 mg/kg kainic acid I.p.. EEGs were recorded and behaviors were contin-uously observed until the end of SE. RESULTS: After the initial akinesia which was apparent within minutes of the KA injection, limbic motor seizure (LMS) composed of facial clonus, head nodding, and akinesia were repeated. Each LMS progressed into more vigorous patterns composed of facial clonus, head nodding, bilateral upper extremity clonus and rearing, without akinesia. Each cycle was repeated as the SE progressed. Severe LMS made up of facial clonus, head nodding, bilateral upper extremity clonus, rearing, falling, and jumping was followed and reiterated. After severe LMS, rats entered subtle SE. In the EEG, repeated discrete seizures mostly consisted of low voltage regular sharp waves and spikes with flat periods. After entering into the LMS, discrete seizure, merging seizure, continuous ictal discharges & periodic epileptiform discharges (PEDs) appeared sequentially in a single cycle and also reiterated. Even during subtle SE, rhythmic cycles were composed of alternating continuous ictal discharges and PEDs. PEDs were gradually replaced by sharp waves or spikes and rats recovered from SE. CONCLUSIONS: Semiologic features and the EEG sequence of KA-induced SE were composed of a series of rhythmic cycles, which have separate EEG patterns in a single cycle. Late EEG patterns of SE were more prominent as the SE progressed.
Animals ; Electrodes ; Electroencephalography ; Head ; Humans ; Kainic Acid ; Male ; Rats* ; Rats, Sprague-Dawley ; Seizures ; Status Epilepticus* ; Upper Extremity

BACKGROUND: Refractory status epilepticus (RSE) requires urgent and effective treatment. Recently, midazolam was suggested as a useful drug in controlling RSE. In order to evaluate the effectiveness and adverse effects of midazolam, we compared midazolam with thiopental sodium. METHODS: Fourteen consecutive RSE in 13 patients from January 1998 to August 1999 were treated. Two RSE were happened in one patient. When the SE was refractory as a result of standard treatment, midazolam and thiopental sodium was alternatively used as therapeutic agent. RESULTS: Out of 9 RSE treated with midazolam, 5 were resolved. Four unresolved RSE received additional thiopental sodium. Thiopental sodium was initially administered in 5 out of 14 RSE. Among the 5 RSE improved by midazolam, no one had midazo-lam- induced hypotension or pneumonia. Three patients had respiratory suppression and needed artificial ventilation. RSE was controlled in 2 out of 4 patients treated with thiopental sodium after midazolam. In these patients, hypoten-sion was developed in 3, pneumonia in 2, and respiratory suppression in all. In 5 RSE treated with thiopental sodium alone, RSE were successfully treated in 3 patients. Complications were hypotension in 2, pneumonia/unknown infec-tion in 3, and respiratory suppression in 4. CONCLUSIONS: Midazolam was comparably effective as thiopental sodium in the treatment of RSE, with less adverse effects. We suggest that midazolam be used in the treatment of RSE before thiopental sodium is administered.
Humans ; Hypotension ; Midazolam* ; Pneumonia ; Status Epilepticus* ; Thiopental* ; Ventilation

BACKGROUND: Immediate early gene (IEG) is supposed to be linked in the continuous seizure induced long-term changes of specific neurons. We tried to investigate the effects of focal interictal epileptiform discharges on the c-JUN expression in the rat brain which is not clearly understood. METHODS:Epidural electrodes were placed on a male Sprague-Dawley weighing 150~230 g and benzathine penicillin (Pc) was applied cortically. After focal interictal epileptiform discharges were successfully identified, EEG was recorded regularly. Cardiac perfusion and extraction of the brain was done at 2, 4, 24 hours and 1 week after the Pc application. Sixteen rats were evenly distributed into 4 groups. Immunocytochemical staining with specific antisera (Santa Cruz) was performed. RESULTS: The epileptiform discharges were induced within an hour after topical Pc applications. At 2 hours after Pc application, c-JUN was moderately expressed in the dentate gyrus (DG) and weakly expressed in the CA3 pyramidal cell, amygdala, pyriform cortex, thalamus, and neocortex. At 4 hours, c-JUN was minimally expressed in DG and other regions. Whereas, at 24 hours, c-JUN was maximally expressed in the DG and also in the CA3 pyramidal cell, amygdala, pyriform cortex, thalamus, and neocortex. One week after Pc application, c-JUN was moderately expressed in the DG and weakly expressed in the CA3 pyramidal cell, amygdala, pyriform cortex, and neocortex. CONCLUSIONS: This data showed that even focal interictal epileptic activity can induce IEG encoded c-JUN protein in the specific distant brain regions of a rat until a late period and the expression pattern showed a synchronous and bimodal pattern.
Amygdala ; Animals ; Brain* ; Dentate Gyrus ; Electrodes ; Electroencephalography ; Humans ; Immune Sera ; Male ; Neocortex ; Neurons ; Penicillin G ; Penicillin G Benzathine ; Perfusion ; Pyramidal Cells ; Rats* ; Rats, Sprague-Dawley ; Seizures ; Thalamus

PURPOSE: The favorable types of the breast cancer - medullary, mucinous, papillary and tubular carcinoma are uncommon subtypes and their incidences in different series ranges between 2.0% and 8.0%, 1% and 2%, 0.3% and 3%, less than 2% of all breast cancers, respectively. In westem countries these subtypes have been reported to have good prognosis and slow growth rate. Clinically, these tumors have lower frequency of axillary nodal involvement and better 5-year or 10-year surviral rate than the other common types of breast cancer. MATERIALS AND METHODS: To determine the clinical characteristics and to evaluate the correlation between the progrostic factors and survival rate of these tumors, the medical records of 83 women with medullary, mucinous, papillary and tubular carcinoma treated at Korea Cancer Center Hospital between Jan. 1987 and Dec. 1997 were reviewed retrospectively. RESULTS: The incidences of medullary, mucinous, papillary and tubular carcinoma were 0.51%, 1.45%, 0.71% and 0.14% of all breast cancer, respectively. There were 1 case of local recurrence and 5 cases of systemic relapse during the follow-up (median follow-up peroid of 56 months). Overall 5-year survival and 10-year survival rate were 98.5% and 94.2%, respectively. No significant difference in overall survival rate was detected according to histologic types of these tumors but disease-free survival was significantly lower in papillary carcinoma than the other types of these tumors (p=0.042). Standard prognostic factors of breast cancer such as tumor size, lymph node status, age of the patient and ER status did not affect the prognosis of these tumors. CONCLUSION: Medullary, mucinous, papillary and tubular carcinoma revealed very excellent prognosis in this study regardless of tumor size, lymph node status, age of the patients and ER status.
Adenocarcinoma* ; Breast Neoplasms* ; Breast* ; Carcinoma, Papillary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Medical Records ; Mucins* ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate