Infection involving the spinal cord and cauda equina are much less common than intracranial infection. Among the above, bacterial infection in spinal epidural space are relatively uncommon but well recognized entity in adult and children. More than 300 cases with spinal epidural abscess are described in the literatures. Because of its rarity, there is delay in diagnosis and irreversible neurological sequelae in high percentage of cases. Infection of the spinal epidural space are accompanied by fever, tachycardia, headache, pain and tenderness in the back, weakness of the lower extremities and finally a complete paraplegia. The modes of infection are 1) direct extension from inflammatory process in adjacent tissues 2) perforating wounds or lumbar puncture 3) hematogenous route from the remote origin. The most frequent causative organism is staphylococcus aureus always, but pneumococcus, streptococcus, pseudomonas, typhoid bacillus, pyocyanus, oidium coccidioides and fungus are causative organisms occasionally. In spinal epidural abscess with complete paraplegia, the neurologic sequelae are permanent and unhappy. So the spinal epidural abscess is neurosurgical emergency in which early diagnosis and prompt surgery are necessary to avert permanent cord damage. Recently, the spinal epidural abscess has increasing tendency. We have treated 5 cases with spinal epidural abscesses from Nov. 1974 to Apr. 1976. The followings are results ; 1) Sex incidence showed male 2, female 3 and age incidence ranged from 21 years to 38 years, but 4th decade was most common. 2) Most common mode of infection was unknown though all cases have been applied the acupunture for the back pain several times. 3) Most avaliable procedures of diagnosis were the usual infectious symptoms, leukocytosis, increased erythrocyte sedimentation rate, obstructive responce by Queckenstedt test and findings of myelography, including increased protein and pleocytosis in cerebrospinal fluid. 4) All 5 cases had been performed total laminectomy from T3-L3, according to the lesions commonly in thoracic spine with spinal epidural abscess and had been treated with penicillin G, Methicillin and Geopen. 5) The prognosis was poor in 4 cases with complete paraplegia but 1 case with incomplete paralysis recovered completely.
Adult ; Bacillus ; Back Pain ; Bacterial Infections ; Blood Sedimentation ; Carbenicillin ; Cauda Equina ; Cerebrospinal Fluid ; Child ; Coccidioides ; Diagnosis ; Early Diagnosis ; Emergencies ; Epidural Abscess* ; Epidural Space ; Female ; Fever ; Fungi ; Headache ; Humans ; Incidence ; Laminectomy ; Leukocytosis ; Lower Extremity ; Male ; Methicillin ; Myelography ; Paralysis ; Paraplegia ; Penicillin G ; Prognosis ; Pseudomonas ; Spinal Cord ; Spinal Puncture ; Spine ; Staphylococcus aureus ; Streptococcus ; Streptococcus pneumoniae ; Tachycardia ; Typhoid Fever ; Wounds and Injuries

Acute subdural hematoma is commonly occurred by severe or minor head injury, which is encountered to neurosurgeons and needed the emergency operation. But the mortality rate of the acute subdural hematoma is still very high(60-90%) in spite of the recently advanced neuroradiology. Neurosurgery and anesthesiology the authors had managed 50 cases of acute subdural hematomas, confirmed surgically, during 24 months from march 1971 to march 1973 and observed clinically. Followings are the results. 1. The male sex was predominantly high in incidence, 6 to 1. the age incidence was high in the 3 rd decade to 5 th decade which is in vigorous social activity. 2. The most common mode of the head injury was the traffic accident in 35 of 50 cases. 15 cases were from other injuries. 3. The level of consciousness of the acute subdural hematoma was various from drowsy consciousness to coma. The lucid interval was developed in 18% of those. 44 cases showed papillary change. 39(88.6%) of these were ipsilateral mydriasis. In 23 of 50 cases had motor disturbance and 78.2% of 23 cases showed contralateral hemiplegia or hemiparesis. The papillary change and hemiplegia were valuable to know the side of hematoma. 4. One of the best diagnostic procedure for the acute subdural hematoma was the angiography. The authors performed the carotid angiography before surgery in all cases. The avascular zone of the angiographic finding was crescentic form in 71.4% of all and the most common site was the parietotemporal region, but rare in the posterior fossa in one case. 5. The mortality rate was 46%. the high mortality was observed in the condition of the old age, persistant coma after surgery, bilateral mydriatic fixed pupil, concomitant profound brain damage and brain swelling. 3 cases of non survival which were in the persistant coma after surgery were died of the complication of severe decubital ulcer, septicemia, pneumonia and cachexia. 6. In 27 survival cases, the hemiplegia, oculomotor palsy, organic dementia and epilepsy were observed as sequelae, which were progressively recovered. 9 of 27 cases were completely recovered to normal social life. But the epilepsy and organic dementia were falt to be the worst sequelae remaining the problem.
Accidents, Traffic ; Anesthesiology ; Angiography ; Brain ; Brain Edema ; Cachexia ; Coma ; Consciousness ; Craniocerebral Trauma ; Dementia ; Emergencies ; Epilepsy ; Hematoma ; Hematoma, Subdural, Acute* ; Hemiplegia ; Humans ; Incidence ; Male ; Mortality ; Mydriasis ; Neurosurgery ; Paralysis ; Paresis ; Pneumonia ; Pupil Disorders ; Sepsis ; Ulcer

OBJECTIVE: This study evaluated the possible role of 2 additional tumor markers to CA125 in discriminating between benign and malignant ovarian tumors. METHODS: Serum samples from 1,346 patients were obtained on seven days before operation. All patients underwent surgery for ovarian tumors. Serum levels of 3 tumor markers were compared to histology. Concentrations of tumor markers (CA125, CA72-4, CA19-9) were detected by enzyme immuno- or immunoradiometric assays. Normal range of these markers was defined as CA125 Humans ; Immunoradiometric Assay ; Reference Values ; Sensitivity and Specificity ; Biomarkers, Tumor*

BACKGROUND: Vascular endothelial growth factor-C (VEGF-C) is a novel growth factor that regulates lymphangiogenesis and/or angiogenesis via binding to the vascular endothelial growth factor receptor-3 (VEGFR-3) or VEGFR-2. Recent studies have suggested that VEGF-C may play a role in lymph node metastasis. This study was conducted to examine whether the expression of VEGF-C is associated with the clinicopathologic parameters, and especially lymph node metastasis, of invasive ductal carcinoma. METHODS: Immunohistochemical staining was performed for VEGF-C and CD31 in the surgically resected specimens from 83 patients with invasive breast carcinoma. RESULTS: Of the 83 breast carcinomas, 61 (74%) cases showed cytoplasmic VEGF-C imunoreactivity. VEGF-C expression was associated with lymph node metastasis (p=0.03), but it did not correlate with tumor size, the histologic grade, and the presence of estrogen receptor or progesteron receptor. The mean microvessel density in the cases without VEGF-C expression was 51.9+/-30.1 and it was 72.9+/-33.0 in the cases with 2+ expression for VEGF-C (p=0.07). CONCLUSIONS: This study suggests that VEGF-C expression may have an association with lymph node metastasis in the patients with breast carcinoma.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Cytoplasm ; Estrogens ; Humans ; Lymph Nodes ; Lymphangiogenesis ; Microvessels ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor C* ; Vascular Endothelial Growth Factor Receptor-2 ; Vascular Endothelial Growth Factor Receptor-3

BACKGROUND/AIMS: HBV infection can be seen after organ transplantation. The presence of anti-Bs in serum means protection from HBV infection. If amino acids were mutated in 'a' determinant which was a common antigenic epitope of HBsAg, escape from humoral immunity can occur. Recently, in chronic HBV infected patients who received liver transplantation but reinfected by HBV, many authors reported mutations in 'a' determinant sequence. However, in renal transplantation, there were few reports about HBV infection and 'a' determinant mutation after transplantation. Therefore, we studied the incidence of HBV reinfection after renal transplantation and also tried to analyze 'a' determinant sequence in those patients. METHODS: We reviewed HBsAg-egative patients who received renal transplantation in our hospital, but turned HBsAg positive after transplantation. We selected two patients who were anti-Bs positive before transplantation but turned HBsAg positive after transplantation, and analyzed 'a' determinant of amino acid sequence of these patients. RESULTS: Among 1682 patients who were HBsAg negative before transplantation, 21 patients were turned HBsAg positive after transplantation. Among them, 6 patients were anti-Bs positive before transplantation. Sequence analysis of the 'a' determinant amino acid in two patients whose HBsAg turned positive after transplantation revealed no evidence of mutation in comparison with previously reported subtype 'a' determinant sequences. CONCLUSION: In renal transplantation, HBV could be reinfected in patients who had been anti-Bs positive before transplantation even without mutation in 'a' determinant region.
Amino Acid Sequence ; Amino Acids ; Hepatitis B Surface Antigens ; Humans ; Immunity, Humoral ; Incidence ; Kidney Transplantation* ; Liver Transplantation ; Organ Transplantation ; Sequence Analysis* ; Transplants ; United Nations

Transfusion-related acute lung injury (TRALI) is a noncardiogenic pulmonary edema that occurs during or within 6 hours after transfusion. Risk factors for TRALI, which is relatively common in critically ill patients, include recent surgery, hematologic malignancy, and sepsis. Here, we report a case of TRALI induced by anti-human leukocyte antigen (anti-HLA) class II antibodies (HLA-DR) occurring after transfusion of platelet concentrates in a patient with acute leukemia. Although most patients with TRALI show improvement within 48-96 hours, our patient's condition rapidly worsened, and he did not respond to supportive treatment. TRALI is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management.
Acute Lung Injury ; Antibodies ; Blood Group Incompatibility ; Blood Platelets ; Critical Illness ; Hematologic Neoplasms ; Humans ; Leukemia ; Leukocytes ; Pulmonary Edema ; Risk Factors ; Sepsis

PURPOSE: To analyse clinical outcome and prognostic factors according to treatment modality, this paper report our experience of retrospective study of patients with esophageal cancer. MATERIALS AND METHODS: One hundred and ten patients with primary esophageal cancer who were treated in Presbyterian Medical Center from May 1985 to December 1992. We analysed these patients retrospectively with median follow up time of 28 months, one hundred and four patients(95%) were followed up from 15 to 69 months. In methods, twenty-eight patients were treated with median radiation dose irradiated 54.3Gy only. Fifty-six patients were treated with combined chemoradiotherapy. Sixteen cases of these patients were treated with concurrent chemoradiation and the other patients(forty cases) were treated sequential chemoradiotherapy. In concurrent chemoradiotherapy group, patients received 5-FU continuous IV infusion for 4 days. Cisplatin IV bolus, and concurrent esophageal irradiation to 30 Gy. After that patients received 5-Fu continuous IV, Cisplatin bolus injection and Mitomycin-C bolus IV, Bleomycin continuous IV, and irradiation to 20 Gy. In sequential chemoradiotherapy group, the chemotherapy consisted of 5-FU 1,000 mg/m2 administered as a continuous 24 hour intravenous infusion during five days and Cisplatin 80-100 mg/m2 bolus injected, or Bleomycin, Vinblastine, Cisplatin, Methotrexate were used of 1 or 2 cycles. After preoperative concurrent chemoradiation, twenty-six patients underwent radical esophagectomy. RESULTS: ninety-three patients could be examined for response assessment. By treatment modality, response rates were 85.1% for radiation alone group and 86.3% for combined chemoradiation group. But in operation group, after one cycle of concurrent chemoradiation treatment, response rate was 61.9%. Ther pathologic complete response were 15.4% in operation group. Overall median survival was 11 months and actuarial 5-year survival rate was 8%. The median survival interval was 6 months for radiation alone group, 11 months for combined chemoradiation group and 19 months for operation group. And also median survival was 19 months for complete responder group that 8 months for noncomplete responder group. In univariative analysis, statistically significant prognositc factors were tumor size, clinical stage, tumor response, and operation. In multivariative analysis, siginificantly better survival was associated with clinical stage, tumor response, radiation dose, and peration. CONCLUSION: Compared with radiotherapy alone, combined mulimodlity may improve the median survival in patients with localized carcinoma of the esophagus and toxicity is acceptable.
Bleomycin ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Esophageal Neoplasms* ; Esophagectomy ; Esophagus ; Fluorouracil ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Methotrexate ; Mitomycin ; Protestantism ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Vinblastine

PURPOSE: Radionuclide cisternography may be helpful in understanding pathophysiology of postural headache and low CSF pressure in patients with spontaneous intracranial hypotension. The purpose of this study was to characterize radionuclide cisternographic findings of spontaneous intracranial hypotension. MATERIALS AND METHODS: The study population consists of 15 patients with spontaneous intracranial hypotension. Diagnosis was based on their clinical symptoms and results of lumbar puncture. All patients underwent radionuclide cisternography following injection of 111 to 222 MBq of Tc-99m DTPA into the lumbar subarachnoid space. Sequential images were obtained between 1/2 hour and 24 hour after the injection of Tc-99m DTPA. Radioactivity of the bladder, soft tissue uptake, migration of radionuclide in the subarachnoid space, and extradural leakage of radionuclide were evaluated according to the scan time. RESULTS: Radionuclide cisternogram showed delayed migration of radionuclide into the cerebral convexity (14/15), increased soft tissue uptake (11/15), and early visualization of bladder activity at 30 min (6/10) and 2 hr (13/13). Cisternography also demonstrated leakage site of CSF in 4 cases and 2 of these were depicted at 30 min. Epidural blood patch was done in 11 patients and headache was improved in all cases. CONCLUSION: The characterstic findings of spontaneous intracranial hypotension were delayed migration of radionuclide and early visualization of the soft tissue and bladder activity. These scintigraphic findings suggest that CSF leakage rather than increased CSF absorption or decreased production may be the main pathophysiology of spontaneous intracranial hypotension. Early and multiple imaging including the bladder and soft tissue is required to observe the entire dynamics of radionuclide migration.
Absorption ; Blood Patch, Epidural ; Diagnosis ; Headache ; Humans ; Intracranial Hypotension* ; Pentetic Acid ; Radioactivity ; Spinal Puncture ; Subarachnoid Space ; Urinary Bladder

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.
Male ; Humans ; Biopsy

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.
Anti-Bacterial Agents/therapeutic use ; Esophageal Diseases/complications/*diagnosis/drug therapy ; Gastroscopy ; Hematemesis/complications/diagnosis ; Humans ; Male ; Mediastinal Emphysema/complications/*diagnosis/drug therapy ; Middle Aged ; Tomography, X-Ray Computed