The authors reviewed the medical records of 94 patients who met the strict diagnostic criteria of spontaneous subarachnoid hemorrhage (SAH). They were diagnosed and treated at Seoul National University Hospital from January 1983 to June 1984. The interrelationships among the age, clinical status on admission, findings on brain computerized tomography (CT), site of the ruptured aneurysm and the intracranial complicaions (ventricular dilatation, vasospasm, rebleeding) and their outcome were studied. Conclusions obtained are as follows: 1) The local clot on CT (especially associated with ICH and /or IVH) was more frequently found in clinically poor patients than in good ones. 2) Cerebral angiography (TFCAs, 53 cases) revealed the anterior communicating artery (A-COM) to be the most common site of aneurysm in 21 cases (39.6%) and multiple aneurysms in 5 cases (9.4% : two in 4 cases, three in 1 case) and no aneurysm in 9 cases (17%). Vasospasm on angiography was found in 27 cases (50.9%). 3) Ventricular dilatation, which was measured on the first CT after SAH, was detected in 43 cases (45.7%). High incidence was found in the cases showing a local clot on CT (53.4%), especially associated with intraventricular hemorrhage (IVH; 83.3%), and in the cases of A-COM aneurysm rupture (52.4%; probably due to IVH). 4) The clinical vasospasm was edtected in 41 cases (43.6%). The interval between SAH and the development of clinical vasospasm ranged from from 3 to 35 days (mean 9.8 days). Thirty-five cases (85.4%) of them suffered from clinical vasospasm within 14 days. The incidence of clinical vasospasm steeply increased in the elderly patients (Fifties: 60%, Sixties: 66.7%) but that of findings of vasospasm on angiography (angiographic vasospasm) slowly increased with age. The local clot on CT seemed to be the most important factor of vasospasm, both clinically (51.7%) and angiographically (75%). The site of vasospasm on angiography was closely related with that of the ruptured aneurysm. 5) Rebleeding occurred in 21 cases (22.3%) with the interval ranging from 2 hours to 38 days (mean 10.1 days) after SAH and 14 cases (66.7%) of them rebled within 10 days. The shorter the interval after SAH, the higher the incidence. There were no definitely related factors affecting the rebleeding but it seemed to be affected to some extent by ICH and/or IVH on CT (31.3%). 6) Thirty-five cases (37.2%) diedof various causes. Mortality seemed to be most closely related with the clinical status on admission. Other related iactros were the aging, the local clot on CT (53.4%), especially associated with ICH and/or IVH (69.7%), and the development of various systemic or intracranial complications. Mortality seemed to be more closely related with ventricuar dilstation and rebleeding than with vasospasm. But it was suggested that vasospasm should be regrarded as a major cause of disabilities and an indirect cause of death.
Aged ; Aging ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteries ; Brain ; Cause of Death ; Cerebral Angiography ; Dilatation ; Hemorrhage ; Humans ; Incidence ; Medical Records ; Mortality ; Rupture ; Seoul ; Subarachnoid Hemorrhage*

Apoptosis is a crucial mechanism for the selective elimination of mammalian cells and is involved in many physiological and pathological processes. The heightened awareness of the importance of apoptosis has increased the need for rapid and quantitative methods for measurement of apoptotic changes. Recently, 7-amino-actinomycin D (7-AAD) has been introduced as a valuable fluorescent dye for assessing apoptosis by flow cytometry. When the cells are stained with 7-AAD in the concentration of 10 - 20 ug/ml, live cells are not stained (7-AAD ) and early apoptotic cells are weakly stained (7-AAD ) while late apoptotic or dead cells are stained brightly (7-AAD). On scattergram of forward angle light scatter vs. 7-AAD fluorescence, the three populations can be discriminated not only between each other but also from cell debris or clumps. The apoptotic cells, defined as 7- AAD cells, were demonstrated as apoptotic by morphological observation of the sorted cells. The 7-AAD cell fraction was also demonstrated to be parallel with subdiploid fraction of cells stained with PL However, 7-AAD cells, whose definition is based on the alteration of membrane integrity, have never been demonstrated to be subdiploid fraction by simultaneous DNA staining. Here we directly demonstrate that 7-AAD cells, defined on the scattergram of forward angle light scatter vs. 7-AAD fluorescence, are subdiploid fraction by staining with DNA dye whose fluorescence is collected after 530/30 band pass filter (FL-1). We also demonstrate the effects of 7-AAD concentration, fixation of cells, and proliferation of cells, on the fluorescence pattern, for reference during assessment of apoptosis by simple and rapid method for flow cytometric analysis of cells stained with 7- AAD. We also present a flow cytometric analysis of cells stained with 7-AAD Eor sequential change in apoptotic fraction, with concurrent dual-color immunophenotyping.
Apoptosis* ; DNA ; Flow Cytometry* ; Fluorescence ; Fluorescent Antibody Technique* ; Immunophenotyping ; Membranes ; Pathologic Processes

OBJECTIVE: Rapid increase in aged population and westernization of lifestyle have modified epidemiological status of stroke. The purpose of this study is to analyze changing trends of stroke epidemiology in South Korea. METHODS: We reviewed retrospectively medical records of 1,124 cases diagnosed as stroke among 54,534 patients who visited the Emergency Medical Center at our hospital from January 1994 to December 1996 (Group A). Also, we evaluated 1,705 cases diagnosed as stroke among 55,381 patients who visited to the same hospital from January 2003 to December 2005 (Group B). The variable features of stroke, such as age, sex, seasonal variation and distribution of stroke subtypes were studied by comparing group A with B. RESULTS: In group A, hemorrhagic stroke (67.9%) was more prevalent than ischemic stroke (32.1%). However, group B showed that the ratio of hemorrhagic stroke (40.3%) to ischemic stroke (59.6%) has been reversed. The highest incidence of stroke was noted in their sixties and seventies of age in group B, which was older than that of group A. In group A, male ischemic stroke (IS) patients outnumbered female patients (1.26:1). Moreover, this gender disproportion became higher in group B (1.53:1). In group A, the number of male intracerebral hermorrhage (ICH) patients were similar to that of female patients (0.97:1). However, male ICH patients outnumbered female patients in group B (1.23:1). As for subarachnoid hemorrhage (SAH), female patients outnumbered male patients more than two-fold in both groups. Both groups showed that the occurrence of ischemic stroke was highest in summer, but that of hemorrhagic stroke was the highest in winter. CONCLUSION: This study showed the changing trends of stroke in its distribution of subtypes. Multicenter prospective study using stroke registry would be required for the determination of national epidemiologic trends.
Aged ; Emergencies ; Female ; Humans ; Incidence ; Life Style ; Male ; Medical Records ; Republic of Korea ; Retrospective Studies ; Seasons ; Stroke ; Subarachnoid Hemorrhage

For evaluating the reproductive performances of GTD patients, we found 115 cases of GTD patients, 77 HM and 38 GTT, who became pregnant after the completion of treatments and follow-up period. The results of this study suggest subsequent pregnancies after the completion of treatments may promise normal reproductive outcomes regardless of the chemotherapy.
Drug Therapy ; Follow-Up Studies ; Gestational Trophoblastic Disease* ; Humans ; Pregnancy

PURPOSE: Recently, the incidence of malignant melanoma has been steadily increasing. Malignant melanoma is already known to have poorer prognosis than other primary skin cancers. Despite the poor prognosis, it is relatively less known to the public so that a number of patients visit hospital carrying advanced stage tumor. Yet, extensive study about malignant melanoma is currently insufficient, and specific guidelines and statistical figures in Korea are almost inexistent. Therefore, authors reviewed patients with malignant melanoma who have visited our hospital for last 14 years. METHODS: Between January 1994 and January 2008, 62 patients were diagnosed with malignant melanoma at our hospital. A retrospective study was performed with data from patients' charts and biopsy results. Annual incidence, mean age of onset, gender, tumor location, tumor thickness, pathologic ulceration, clinicopathologic subtype, and clinical AJCC stage were evaluated. Analysis of factors associated with survival were performed using the Cox proportional hazard model. Kaplan-Meier method was used to generate survival curves. RESULTS: Clinicopathologic features of 62 patients (32 male, 30 female) with average age of 57 years were evaluated. Most lesions were found in lower limb, and the most common subtype was acral lentiginous melanoma. We could also find that age, tumor thickness, and clinical stage were the only significant prognostic factors. CONCLUSION: Clinicopathologic features of malignant melanoma were analyzed in this study, but the result is not ready to be generalized because of the limited number of cases. Further study must be performed to report clinical guidelines for prognosis and treatment for malignant melanoma patients in Korea.
Age of Onset ; Biopsy ; Humans ; Incidence ; Korea ; Lifting ; Lower Extremity ; Male ; Melanoma ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Skin Neoplasms ; Survival Rate ; Ulcer

A common goal of plastic and reconstructive surgery is to provide ideal tissue replacement for defect with optimal aesthetic and functional results. Tissue expansion has been one of best methods that satisfies both aesthetic and functional requirements. But the need for chronic judicious expansion over many weeks and months has limited this use. Additional disadvantage of this technique is the cosmetic or functional deformity that may be associated with the buried expander and remote valve. Intraoperative expansion can be made the rapid skin expansion possible. This was useful method used for closing small skin defects with minimal tension or distortion. But previous intraoperative tissue expansion needs expansive tissue expander. Authors developed simple and inexpensive ISLE(Intraoperative Sustained Limited Expansion) technique without the use of tissue expander. Using consecutive gauze, tissue expansion was done. We could successfully repair 3-4cm wide soft tissue defect with this method. Before mass or scar excision, small incision was made at center of lesion. After the wide pocket undermined under incision, we put the maximum gauze into the pocket. Towel clip was used for temporarily approximation with cyclic and serial expansion. Skin lesion was completely excised and repaired with ease. We achieved good functional and cosmetic results from 34 patients over the last 18 months. Complications such as wound dehiscence, hematoma, flap necrosis were not noted.
Cicatrix ; Congenital Abnormalities ; Hematoma ; Humans ; Necrosis ; Plastics ; Skin ; Tissue Expansion Devices ; Tissue Expansion* ; Wounds and Injuries

Any types of burn injury that involve more than deep dermis often require reconstructive treatment. In gluteal region, V-Y fasciocutaneous advancement flap is frequently used to cover the defect. However, in case of large burn wounds, this kind of flap cannot provide adequate coverage because of the lack of normal surrounding tissues. We suggest V-Y adipofascial flap using the surrounding superficially damaged tissue. We present the case of a patient who was referred for full-thickness burn on gluteal region. We performed serial debridement and applied vacuum-assisted closure device to defective area as wound preparation for coverage. When healthy granulation tissue grew adequately, we covered the defect with surrounding V-Y adipofascial flap and the raw surface of the flap was then covered with split-thickness skin graft. We think the use of subcutaneous fat as an adipofascial flap to cover the deeper defect adjacent to the flap is an excellent alternative especially in huge defect with uneven depth varying from subcutaneous fat to bone exposure in terms of minimal donor site morbidity and reliability of the flap. Even if the flap was not intact, it was reuse of the adjacent tissue of the injured area, so it is relatively safe and applicable.
Burns* ; Buttocks* ; Debridement ; Dermis ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Skin* ; Subcutaneous Fat ; Tissue Donors ; Transplants* ; Wounds and Injuries

In adult congenital muscular torticollis (CMT) patients, physical therapy is not as effective because the development of sternocleidomastoid muscle (SCM) muscle is complete. While surgical release can address CMT in adult patients, the risk of general anesthesia and visible postoperative scar is a concern, expecially in patients with mild symptoms. In this paper, we report our experience in treating such patients with minimal-incision myotomy under local anesthesia. A review was performed for all adult patients who had undergone the simple myotomy procedure. Surgical indication was reserved for patients with mild fibrotic band in the SCM muscle with minimal lengthdiscrepancybetween the muscles. All patients had recognizable head tiltand palpation of fibrotic band on affected side of the neck. Surgical details are described in the main body of text. Three female patients had undergone the procedure. Torticollis was resolve in all patients with complete restoration of ranage of motion. There were no postoperative complications, and patient satisfaction was high. We have reported three cases of mild CMT in adult female patients, who had undergone minimal-incision myotomy under local anesthesia. Outcomes were satisafactory with no morbidity to report. With careful patient selection, this method offers an alternate treatment option for adult CMT patients with mild symptoms.
Adult* ; Anesthesia, General ; Anesthesia, Local* ; Cicatrix ; Female ; Head ; Humans ; Muscles ; Neck ; Palpation ; Patient Satisfaction ; Patient Selection ; Postoperative Complications ; Torticollis*

BACKGROUND: Preauricular sinuses represent a common congenital abnormality in children. Classically, a preauricular sinus manifests as a small opening, usually near the anterior limb of ascending helix. The difficulty in the surgical treatment of preauricular sinus is the high recurrence rate. The aim of this article is to review the outcomes of preauricular sinus and to introduce our surgical technique and its prognosis. METHODS: A single-institutional retrospective review was performed for all patients who had undergone excision of congenital periauricular sinus between October 2007 and April 2014. Medical records were reviewed for demographic information, wound complication, and recurrence rate. The sinus tract was visualized with the aid of preoperative dye instillation and intraoperative probe insertion. The skin next to the sinus opening was incised elliptically, and the tract itself was dissected medially to the end of the sinus tract and posteriorly to the cartilage of the ascending helix. RESULTS: The review identified 44 patients for a total of 57 preauricular sinus tracts. The mean age at time of operation was 16.3 years with a range from 9 months to 65 years. Unilateral preauricular sinus tract was present in 31 patients (11 right and 20 left preauricular tract), and 13 patients had bilateral sinus tract. None of the patients had experienced wound issues postoperative, and there were no recurrent sinus tract formation or infection. CONCLUSION: Using a combination of dye instillation, probe insertion, and modified dissection, we were able to achieve a recurrence free series of preauricular sinus tract excision among a heterogenous group of patients. A large patient series is necessary to replicate the results of this study.
Cartilage ; Child ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Medical Records ; Prognosis ; Recurrence ; Retrospective Studies ; Skin ; Wounds and Injuries

Immobilization of skin graft is essential in split thickness skin graft. A common practice to ensure immobilzation is tie-over dressing. Tie-over dressing is used to secure skin graft and to avoid complications such as fluid accumulation and hematoma formation. But the traditional technique of tie-over dressing is a time-consuming tedious task. Various modifications of this method have been developed. But almost all the methods required the silk tie as well as special devices. We designed simple and effective immobilization method of skin graft that is neither threads nor securing devices are required. After skin graft is applied to recipient bed, skin staples are used to tack the graft. Vaseline gauze is applied over the graft. A fluffy gauze bolus is placed over the vaseline gauze and wrapped around the bolus with mesh gauze. The skin staples are used to secure the free ends on the bolus dressing applying proper tension. These free ends of the mesh gauze, acting like two-dimensional threads, put a pressure on the bolus dressing and the graft. This method has been used in 30 patients and has proven satisfactory.
Bandages* ; Hematoma ; Humans ; Immobilization ; Petrolatum ; Silk ; Skin* ; Transplants*