BACKGROUND: The differentiation between hemorrhagic(HS) and norhemorrhagic(NHS) stroke is the most important first step in the management of acute stroke because clinical management of the two disorders differs substantially. Neuroimaging studies are useful in diagnosing and distinctioning between HS and NHS. The use of clinical variables, such as Siriraj stroke scores(SSS), has led to good sensitivity, specificity and predictive values. The aim of our study was to evaluate the use of the SSS in the Korean population and assess whether it could aid to expedite treatment decisions. METHODS: We reviewed 111 cases of stroke patients admitted to our hospital via the emergency department over a 6 months period from July to December 1998. Levels of consciousness, vomiting, headache, and atheroma markers used in the SSS were applied to these patients who met the criteria for a stroke. RESULTS: Of the 111 patients, the SSS classified 83 with sensitivities of 81.1%(NHS) and 73.3%(HS) and positive predictive values of 84.3% and 68.8%, respectively. The overall accuracy rate was 78.3%. CONCLUSION: Our results suggest that the SSS is not reliable in distinguishing stroke types in the Korean population. Definite neuroimaging studies are needed prior to thrombolytic therapy.
Consciousness ; Emergency Service, Hospital ; Headache ; Humans ; Neuroimaging ; Plaque, Atherosclerotic ; Sensitivity and Specificity ; Stroke* ; Thrombolytic Therapy ; Vomiting

BACKGROUND: Incidence of traumatic hip dislocation have ween increased with development of transportation. Traumatic hip dislocation demands early recognition as an emergency and prompt reduction. So we designed this study to determine what kinds of factors affect the prognosis of the patient. METHODS: Eighty five patients who admitted emergency department of our hospital with the traumatic hip dislocation were enrolled in this study. Cause of injury, type of dislocation, method of reduction, the time from dislocation to reduction, age, gender and associated patellar injury were evaluated by retrospective chart reviews. RESULTS: Average age of excellent and good group(E&G) is 28+/-17.8 and fair and poor group(F&P) is 39+/-18.6, so the older the age the more poor prognosis(P<0.05). The time to take reduction of E&G group is 18+/-8.2 hours and F&P group is 25+/-12.6 hours, so the faster the better prognosis(P<0.05). We classify the type of hip dislocation by Thompson and Epstein method, type I to type V. The prognosis of type I is better than type V(P<0.05). Fifty five case were associated with patellar injury and they had poor prognosis than the other cases that were not associated with knee joint injury. CONCLUSION: In traumatic dislocated hip patients, the prognosis was poor in old age, delay in reduction, higher type of dislocation and associated with knee joint injury.
Dislocations ; Emergencies ; Emergency Service, Hospital ; Hip Dislocation* ; Hip* ; Humans ; Incidence ; Knee Joint ; Prognosis* ; Retrospective Studies ; Transportation

BACKGROUND: NO (nitric oxide), derived from L-arginine through the action of nitric oxide synthase (NOS), is a short-lived free radical transmitting cellular signals for vasodilation, neurotransmission, and cytotoxicity. Recently, this molecule has been reported to be involved in the various glandular secretion. Although the relationship between NO and the pancreatic endocrine secretion has been widely investigated, the role of NO on insulin secretion has not been elucidated. Therefore, the present study was designed to reveal the precise action of NO on the secretion and synthesis of insulin following administration of NAME (L-NG -nitroarginine methyl ester) or L-arginine using immunocytochemistry and in situ hybridization techniques. METHODS: NAME or L-arginine was administered into jugular vein of the male Sprague-Dawley rat (180~200 g, b,w.) exhibiting normoglycemia (80~120mg/dL). Blood glucose concentrations were measured at intervals of 30 minutes for 2 hours after drug treatment. The pancreatic tissues were taken out at 30 and 90 minutes following drugs administration for insulin immunocytochemistry and in situ hybridization. RESULTS: Both NAME and L-arginine treatments diminished blood glucose levels. The decrease of blood glucose level was more prominent in NAME-treated rats than that of L-arginine. Insulin immunoreactivity in drugs-treated rat pancreas decreased compared to that in normal control, while the expression of insulin mRNA was significantly increased. CONCLUSION: On the basis of present study, it is concluded that the transient changes of NO con-centration, regardless of increase or decrease, in Langerhans islet might act as a potent stimulant in insulin secretion and its synthesis.
Animals ; Arginine ; Blood Glucose ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Insulin* ; Jugular Veins ; Male ; Nitric Oxide Synthase ; Nitric Oxide* ; Pancreas* ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Synaptic Transmission ; Vasodilation

PURPOSE: Dipyridamole stress myocardial perfusion SPECT could predict prognosis, however, long-term follow-up showed change of hazard ratio in patients with suspected coronary artery disease. We investigated how long normal SPECT could predict the benign prognosis on the long-term follow-up. MATERIALS AND METHODS: We followed up 1169 patients and divided these patients into groups in whom coronary angiography were performed and were not. Total cardiac event rate and hard event rate were predicted using clinical, angiographic and SPECT findings. Predictive values of normal and abnormal SPECT were examined using survival analysis with Mantel-Haenszel method, multivariate Cox proportional hazard model analysis and newly developed statistical method to test time-invariance of hazard rate and changing point of this rate. RESULTS: Reversible perfusion decrease on myocardial perfusion SPECT predicted higher total cardiac event rate independently and further to angiographic findings. However, myocardial SPECT showed independent but not incremental prognostic values for hard event rate. Hazard ratio of normal perfusion SPECT was changed significantly (p<0.001) and the changing point of hazard rate was 4.4 years of follow up. However, the ratio of abnormal SPECT was not. CONCLUSION: Dipyridamole stress myocardial perfusion SPECT provided independent prognostic information in patients with known and suspected coronary artery disease. Normal perfusion SPECT predicted least event rate for 4.4 years.
Coronary Angiography ; Coronary Artery Disease ; Dipyridamole* ; Follow-Up Studies ; Humans ; Perfusion ; Prognosis ; Proportional Hazards Models ; Tomography, Emission-Computed, Single-Photon*

Schwannoma is a benign, solitary tumor which may occur from nerve sheath of the peripheral, sympathetic and cranial nerves and so on except optic and olfactory nerves which have no nerve sheath themselves. Although it occurs most frequently in the head and neck region especially in the acoustic nerve, the schwannoma of the tongue is rare. Recently, we have experienced a case of schwannoma of the tongue in a 13-year-old female. Now we report the case with literature review.
Adolescent ; Cochlear Nerve ; Cranial Nerves ; Female ; Head ; Humans ; Neck ; Neurilemmoma* ; Olfactory Nerve ; Tongue*

PURPOSE: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. RESULTS: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 6.8%. CONCLUSION: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.
Abdominal Abscess ; Gastrectomy* ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreas ; Pancreatic Fistula ; Retrospective Studies ; Spleen ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.
Adult ; Americas ; Classification ; Communicable Diseases ; Diagnosis ; Female ; Gangwon-do ; Heart ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Intensive Care Units ; Korea* ; Legionella pneumophila* ; Legionella* ; Legionnaires' Disease ; Mortality ; Pneumonia*

Congenital agenesis, aplasia or hypoplasia of the internal carotid artery is rare vascular disease and usually combine with intracranial aneurysm, subarachnoid hemorrhage, or intracerebral hemorrhage. We report a case of bilateral congenital hypoplasia of internal carotid artery in a 36 year-old woman presented with semicomatose mentality. The brain computed tomography(CT) revealed intracerebral hemorrhage with intraventricular hemorrhage, and cerebral angiography showed hypoplasia of bilateral internal carotid artery without narrowing of the bony carotid canal on the temporal bone CT.
Adult ; Brain ; Carotid Artery, Internal* ; Cerebral Angiography ; Cerebral Hemorrhage ; Female ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Subarachnoid Hemorrhage ; Temporal Bone ; Vascular Diseases

Intracranial lipoma is a rare benign brain tumor and ususally occurs in the midline structures, especially in the corpus callosum. The author report a case of intracranial lipoma in the left sylvian cistern. Sylvian cistern lipomas may be asymptomatic or present with epileptic seizures due to irritation of the cortex of the sylvian fissure. The majority of cases are incidental or autopsy findings and direct surgical approach is only rarely indicated. The patient complained severe headache after head injury, the severe headache did not respose to medical therapy. Craniectomy was performed and then the tumor was removed. The literatures on this rare tumor are reviewed and discussed.
Autopsy ; Brain Neoplasms ; Corpus Callosum ; Craniocerebral Trauma ; Epilepsy ; Headache ; Humans ; Lipoma*

BACKGROUND: In athlete's heart, functional and structural alteration are main features. We studied electrocardiograms(ECG's) and echocardiograms(UCG's) in soccer players before and after intensive training. METHODS: Fifteen soccer players with the mean age and career of 19.3 and 8.5 years,respectively,underwent intensive training for 5-5.5 months, which included running of 2 km daily during the last 2-2.5 months. Comparisons of ECG's and UCG's recorded before and after the training were made. RESULTS: The major abnormal finding in pre-training ECG's was high voltage being seen in 40% of the cases, and in UCG's left ventricular(LV) dilatation and/or hypertrophy or asymmetrical septal hypertrophy(ASH) were noted in approximately 80% of the cases. The incidences of these finding after the intensive training were essentially unchanged, and the mean of pre-and post-training fractional shortening(FS) and LV and left atrial dimensions were similar. The high voltage in ECG's showed no close correlation with LV dilatation or hypertrophy on UCG's. After the training, however, the mean values of the thickness of LV posterior wall and ventricular septum along with LV mass were significantly increased, and the right ventricular dimension was significantly decreased. CONCLUSIONS: The most frequent finding in ECG's and UCG's in soccer players, before and after intensive training,were high voltage, LV dilatation and /or hyperophy with or without ASH. The intensive training of 5-5.5 months duration caused no change in F8,but caused significant increase in the thickness of LV posterior wall and ventricular septum, and LV mass.
Dilatation ; Electrocardiography* ; Heart ; Hypertrophy ; Incidence ; Running ; Soccer* ; Ventricular Septum