A retrospecive clinical observation was done on 325 cases of hypertension admitted to Department of internal Medicine of Seoul Red Cross Hospital from January, 1979 to December, 1982. The following results have been obtained. 1) The observed patients were 157 males and 168 females, and the prevalence rate of malignant hypertension among 325 hypertensions was 16 cases (4.9 percent). Among 16 cases of malignant hypertension 9 cases were male and 7 cases were female. Most frequently in 50, 60 and 40 years of age in this order each sex. 2) The average admitted dates are 7 days. 27 cases (8.3percent) were readmitted above 2 times after one discharged. 3) The most freqeuntly observed duration of Known hypertension 37.9 percent was 6-10 years and the next frequently observed duration 37.4 percent was 3-5 years. 4) The highest percentage of malignant hypertension had systolic blood pressure between 190-209mmHg and diastolic blood pressure between 150-169mmHg. 5) The highest percentage of seasonal number was spring (31.1 percent) and the next autumn, summer, winter in this order and the prevalence rates of hypertention are increased average 1.9% of each year. 6) The 78.5 percent of the patients were found that their blood pressure were abnormaly high when they were examined with related symptoms on admission, and they major symptorms were headache and dizziness. 7) The physical examination on admission, tachycardia (56percent), tachypnea (15.1percent), semicoma to coma (12.9 percent) in this order. 8) The status of treatment in hypertension on admission was as follows; imtermittent treatment 54.5 percent, no treatment 31 percent and continuous treatment 14.5 percent in this order. 9) In the chest X-ray on admission, the most frequent finding was cardiomegaly, and normal finding was the next frequency. The pulmonary Tbc was noted in 12.6 percent. 10) According to the degree of fundoscopic abnormality by K-W classification stage III was 68.8 percent and stage IV was 31.2 percent. 11) Electrocardiogram abnormalities were 44.9 percent, and 87.5 percent of malignant hypertension revealed electrocardiographic abnormalities and left ventricle hypertrophy was observed in 70.5 percent. 12) Hypercholesterolemia 78 percent, Hypernatremia 69.8 percent, Hypokalemia 22.8 percent, serum chloride 34.5 percent (<95m Eg/l), BUN 53.8 percent (>20mg/dl) and creatinine 45.8 percent (>3mg/dl) on admission. 13) Proteinuria was observed in 87.5 percent of malignant hypertension. 14) Marked improved for clinically was 24 percent and mortality rate was 5.2 percent, most common cause of death are cardiovascular accident (64.7percent) and renal failure (23.5percent).
Blood Pressure ; Cardiomegaly ; Cause of Death ; Classification ; Coma ; Creatinine ; Dizziness ; Electrocardiography ; Female ; Headache ; Heart Ventricles ; Humans ; Hypercholesterolemia ; Hypernatremia ; Hypertension ; Hypertension, Malignant ; Hypertrophy ; Hypokalemia ; Internal Medicine ; Male ; Mortality ; Physical Examination ; Prevalence ; Proteinuria ; Red Cross ; Renal Insufficiency ; Seasons ; Seoul ; Tachycardia ; Tachypnea ; Thorax

Heterotopic pregnancy, simultaneous intrauterine and extrauterine gestations, is a relatively rare conditon with an estimated incidence of 1 in 30,000 pregnancies in a natural cycle. But the incidence of heterotopic pregnancies has been increased because of rising incidence of pelvic inflammatory disease, pelvic surgery, intrauterine device, the use of various ovulation induction and assisted reproductive technologies, such as in vitro fertilization and embryo transfer, gamate intrafallopian insemination. The early diagnosis of heterotopic pregnancy is very difficult. So there is a higher maternal morbidity, mortality and fetal loss. Thus careful pelvic examination, combined with serial beta hCG determinations and transvaginal sonography to evaluate the adnexal region are important. We experienced a case of 34-years-old multiparous women with heterotopic pregnancy in natual cycle confirmed by surgical removal of ruptured right tubal pregnancy and sonographic finding of the intrauterine pregnancy, which carried the intrauterine pregnancy to term delivery without complication at 39+5 weeks of gestation, and report this case with a brief review of the literature.
Early Diagnosis ; Embryo Transfer ; Female ; Fertilization in Vitro ; Fertilization* ; Gynecological Examination ; Humans ; Incidence ; Insemination ; Intrauterine Devices ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal ; Reproductive Techniques, Assisted ; Ultrasonography

OBJECTIVE: Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. METHODS: Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. RESULTS: Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. CONCLUSION: Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization.
Aneurysm* ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Mortality ; Neck* ; Retrospective Studies ; Surgical Instruments

The hypokalemic periodic paralysis is characterized by intermittent falccid paralysis of extremities with spontaneous recovery. It is rarely accompanied by cardiac arrhythmia, especially fatal ventricular tachycardia or torsades de pointes. We observed a 29 year old man, who had suffered from intermittent periodic paralysis and fatal ventricular tachyarrhythmia. He had the first episode of muscle weakness in his low grade of elementary school, which lasted for 20 -30 hours. Similar episodes of muscle weakness occurred 1 -7 times per year, especially after carbohydrate rich food. On admission to emergency room, his chief complaints were generalized weakness and chest tightness, serum potassium level was 1.6mEq/l, and four extremities showed Grade 0 motor weakness. His electrocardiography(ECG) showed Atrioventricular dissociation due to sinus tachycardia and accelerated junctional rhythm, intraventricular conduction distrubance. During intravenous potassium administration, ECG showed sustained ventricular tachycardia and cardiovascular collapse occurred. So we carried out resuscitation and cardioversion. After resuscitation, he recovered from cardovascular collapse and ECG showed sinus tachycardia. But during continuous monitoring ECG showed torsades de pointes with cardiovascular collapse. We carried out resuscitation and defibrillation repeatedly. Serum potassium level was 1.7 - 1.8mEq/L at that time. After successful resuscitation, ECG showed sinus rhythm, and his mental status was fully recovered. After he admitted to intensive care unit, paralytic attack and cardiac arrhythmia did not occurred any more. Serum potassium level was maintained between 3.9 -6.1lmEq/L during his hospital days. He was fully recovered but could not take any medications(e.g. acetazolamide, potassium supplying agent and antiarrhythmic drugs) due to severe gastrointestinal disturbances. During the 30 months of postdischarge period, he experienced three mild paralysis attacks, but they were not accompanied by chest tightness, palpitation or syncope.
Acetazolamide ; Adult ; Arrhythmias, Cardiac* ; Electric Countershock ; Electrocardiography ; Emergency Service, Hospital ; Extremities ; Heart Block ; Humans ; Hypokalemia ; Hypokalemic Periodic Paralysis* ; Intensive Care Units ; Muscle Weakness ; Paralysis ; Potassium ; Resuscitation ; Syncope ; Tachycardia ; Tachycardia, Sinus ; Tachycardia, Ventricular ; Thorax ; Torsades de Pointes

A 36-year-old man visited Yeungnam University Hospital with a sudden onset of palpitation, headache, and was found to be hypertensive. Chest radiography showed a 6 cm sized mass lesion on the posterior mediastinum. A biochemical study showed elevated levels of catecholamines. An I-123 metaiodobenzylguanidine scan revealed a hot uptake lesion on the posterior mediastinum. The patient was prepared for surgery with alpha and beta blocking agents. Two months later, we removed the tumor successfully. A histological study proved that the resected tumor was mediastinal pheochromocytoma. Functional mediastinal pheochromocytomas are rare. Therefore, we reported the case with a literature review.
Catecholamines ; Headache ; Humans ; Hypertension ; Mediastinum ; Pheochromocytoma ; Thorax

A 51-year-old woman visited our hospital with massive hemoptysis. She had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times. The patient had a history of pulmonary tuberculosis and bronchiectasis. Chest radiography showed consolidation around the nodule in the lateral basal segment of the right lower lobe. We successfully performed a right lower lobectomy. The histological study of the resected specimen showed a vegetable foreign body and clumps of Actinomyces, indicating actinomycosis, which was suggested to be the cause of the hemoptysis. This was a very rare case of hemoptysis caused by a vegetable foreign body and actinomycosis.
Actinomyces ; Actinomycosis* ; Bronchial Arteries ; Bronchiectasis ; Female ; Foreign Bodies* ; Hemoptysis ; Humans ; Middle Aged ; Radiography ; Thorax ; Tuberculosis, Pulmonary ; Vegetables*

BACKGROUND: Numerous statistical models have been developed to accurately predict outcomes in multiple trauma patients. However, such trauma scoring systems reflect the patient's physiological condition, which can only be determined to a limited extent, and are difficult to use when performing a rapid initial assessment. We studied the predictive ability of the systemic inflammatory response syndrome (SIRS) score compared to other scoring systems. METHODS: We retrospectively reviewed 229 patients with multiple trauma combined with chest injury from January 2006 to June 2011. A SIRS score was calculated for patients based on their presentation to the emergency room. The patients were divided into two groups: those with an SIRS score of two points or above and those with an SIRS score of one or zero. Then, the outcomes between the two groups were compared. Furthermore, the ability of the SIRS score and other injury severity scoring systems to predict mortality was compared. RESULTS: Hospital death occurred in 12 patients (5.2%). There were no significant differences in the general characteristics of patients, but the trauma severity scores were significantly different between the two groups. The SIRS scores, number of complications, and mortality rate were significantly higher in those with a SIRS score of two or above (p<0.001). In the multivariant analysis, the SIRS score was the only independent factor related to mortality. CONCLUSION: The SIRS score is easily calculated on admission and may accurately predict mortality in patients with multiple traumas.
Emergency Service, Hospital ; Humans ; Inflammation* ; Models, Statistical ; Mortality* ; Multiple Trauma* ; Retrospective Studies ; Systemic Inflammatory Response Syndrome ; Thoracic Injuries

There have been few reports of manifestations such as vasculitis, nephrosis, neuritis, encephalitis, and serum sickness occuring in a temporal relation to insect stings. Symptoms usually start several days to several weeks after the sting and may last for a long time. Angioedema with eosinophilia induced by bee sting has not reported in medical literature. We report a case of eosinophilia with angioedema induced by bee venom in a 30-year-old woman whom presented with edema of extremities and peripheral blood eosinophilia. The patient had high titer of specific IgE to yellow jacket venom.
Adult ; Angioedema* ; Bee Venoms ; Bees* ; Bites and Stings* ; Edema ; Encephalitis ; Eosinophilia* ; Extremities ; Female ; Humans ; Immunoglobulin E ; Insect Bites and Stings ; Nephrosis ; Neuritis ; Serum Sickness ; Vasculitis ; Venoms ; Wasps

BACKGROUND: Many methods have been proposed for the correction of sunken upper eyelids. These methods include surgical treatments, such as micro-fat, dermofat, or fascia-fat grafts, or the use of alloplastic materials. Here, we present our experience of sunken upper eyelid correction involving the simple addition of anchoring the central fat pad to the medial fat pad during upper blepharoplasty. METHODS: We performed 74 cases of upper blepharoplasty with sunken upper eyelid correction between October 2013 and September 2014. The lateral portion of the central fat pad was partially dissected to facilitate anchoring. The medial fat pad was gently exposed and then pulled out to facilitate anchoring. After the rotation of the dissected lateral portion of the central fat pad by 180degrees to the medial side, it was anchored spreading to the medial fat pad. Photographs taken at 6 months postoperatively were presented to three physicians for objective assessment. Of the 74 patients, 54 patients followed at 6 months postoperatively were included in this retrospective, objective assessment. RESULTS: Sunken eyelids were effectively corrected in 51 of the 54 patients, but 3 had minimal effect because preaponeurotic fat pads had been removed during previous upper blepharoplasty. In addition to correcting sunken eyelids, lateral bulging was corrected and a better definition of the lateral portion of upper lid creases was obtained. CONCLUSIONS: Anchoring the central fat pad to the medial fat pad provides an effective means of correcting sunken upper eyelids during upper blepharoplasty.
Adipose Tissue* ; Blepharoplasty* ; Esthetics ; Eyelids* ; Humans ; Retrospective Studies ; Transplants

PURPOSE: The objective of this study was to compare the clinicopathologic characteristics of the patients with extrahepatic bile duct cancer between the patients who are younger than 54 years and those who are older than 75 years. METHODS: Between 1994 and 2008, 63 patients underwent resectional surgery or palliative treatment for extrahepatic bile duct cancer. The medical records of these patients, including the clinicopathologic characteristics and the other relevant data, were retrospectively reviewed. RESULTS: There were some differences between the patient groups for the tumor location, distant metastasis and preoperative co-morbidity. The frequency of tumor locations were 58% proximal, 13% middle, 22% distal and 5% diffuse in the young patients and these were 33%, 18%, 48% and 0%, respectively, in the older patient group (p=0.049). The frequency of distant metastasis was 13% in the young patient group and none in the older patient group (p=0.026). The elderly patient group showed more preoperative co-morbidities (68% vs 29%, respectively) (p=0.009), but there was no statistical difference between the two groups for postoperative complications (p=0.301). There was no correlation between the preoperative co-morbidity and the operative complications for both groups. There were no differences in the other clinicopathologic characteristics and the survival rate for both groups. CONCLUSION: Young and elderly patients with extrahepatic bile duct cancer had different clinicopathologic characteristics. Especially, in the young patients, there were more proximally located-tumors and distant metastases. Although there were more preoperative co-morbidities in the elderly patient group over the age of 75, this did not affect the operative complication rate when the co-morbidities were well controlled preoperatively.
Aged ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Extrahepatic ; Humans ; Medical Records ; Neoplasm Metastasis ; Palliative Care ; Postoperative Complications ; Retrospective Studies ; Survival Rate