Nine patients of mean age 47.8 years, with suspected sinus node dysfunction, underwent extensive electrophysiological studies. Sinus bradycardia(6the electrophysiological study, AH and HV intervals were prolonged in 2/9 and 1/9 patients, respectively. Maximal sinus node recovery times were prolonged in 7/9 patients, ranging from 1,330 msec to 12,330msec. Sinoatrial conduction times measured by atrial premature stimulation technique were prolonged in 5/7 patients, ranging from 137msec to 310 msec. And sinoatrial conduction time measured by continuous pacing technique also revealed prolonged value in 4/6 patients ranging from 140 msec to 195 msec. The effective refractory periods, of atrium were prolonged in 6/8 patients (320 msec to 470 msec). The effective and functional refractory periods of AV node were prolonged in 3/8 patients (440 csec to 490 msec) and 4/8 patients (530 msec to 560 msec), respectively. Retrograde VA conduction could be observed in 3/7 patients and ventricular effective refractory periods were normal in 7/7 patients. Atrial flutter was induced in 1/9 patients by electric stimulation during electrophysiological study. Above data suggest that the electrophysiological study is very useful in assessing the sinus node function and other electrophysiological properties in sick sinus syndrome patients and also suggest that the data could be utilized in choosing the proper mode of artificial pacemaker for each patient.
Atrial Flutter ; Atrioventricular Node ; Electric Stimulation ; Humans ; Pacemaker, Artificial ; Sick Sinus Syndrome* ; Sinoatrial Node

BACKGROUND: There exist considerable debates concerning about the effects of epilepsy surgery on cognitive function. To evaluate the effects of tailored anterior temporal lobectomy with amygdalohippocampectomy (ATLAH) on intelligence and memory, we compared the pre- and post-operative cognitive function in patients with mesial temporal lobe epilepsy (MTLE). METHODS: Thirty six patients who received unilateral tailored ATLAH from 1993 to 1997 and had been seizure-free for at least two years postoperatively were selected. Mean age at the time of surgery was 26.8 years and mean period of postoperative follow-up was 47 months. The change of cognitive function was assessed pre-and post-operatively using Korean Wechsler Adult Intelligence Scale (K-WAIS) and Rey memory test. We also assessed the correlation between the extent of hippocampal and lateral temporal cortical resection and cognitive changes respectively. RESULTS: In total patients (N=36), there was statistically significant improvement in performance IQ (PIQ, p<0.05), full scale IQ (FIQ, p<0.05), and auditory verbal learning test (AVLT). In the right temporal lobectomy group (N=16), improvement in PIQ, FIQ, and AVLT reached to statistical significance (p<0.05). In the left temporal lobecto-my group (N=20), improvement in PIQ was significant (p<0.05). In terms of the size of resection, there were tendencies that the cognitive function is more improved in patients with larger hippocampal resection (>2 cm) and in patients with smaller temporal cortical resection (4 cm). CONCLUSIONS: Patients became seizure free after tailored ATLAH may have improvement in performance IQ and full scale IQ. Right side resection, larger hippocampal resection, and smaller lateral temporal resection show better postoperative cognitive function. (J Korean Neurol Assoc 19(2):116~124, 2001)
Adult ; Anterior Temporal Lobectomy* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Intelligence* ; Memory* ; Seizures ; Temporal Lobe* ; Verbal Learning

BACKGROUND: There exist considerable debates concerning about the effects of epilepsy surgery on cognitive function. To evaluate the effects of tailored anterior temporal lobectomy with amygdalohippocampectomy (ATLAH) on intelligence and memory, we compared the pre- and post-operative cognitive function in patients with mesial temporal lobe epilepsy (MTLE). METHODS: Thirty six patients who received unilateral tailored ATLAH from 1993 to 1997 and had been seizure-free for at least two years postoperatively were selected. Mean age at the time of surgery was 26.8 years and mean period of postoperative follow-up was 47 months. The change of cognitive function was assessed pre-and post-operatively using Korean Wechsler Adult Intelligence Scale (K-WAIS) and Rey memory test. We also assessed the correlation between the extent of hippocampal and lateral temporal cortical resection and cognitive changes respectively. RESULTS: In total patients (N=36), there was statistically significant improvement in performance IQ (PIQ, p<0.05), full scale IQ (FIQ, p<0.05), and auditory verbal learning test (AVLT). In the right temporal lobectomy group (N=16), improvement in PIQ, FIQ, and AVLT reached to statistical significance (p<0.05). In the left temporal lobecto-my group (N=20), improvement in PIQ was significant (p<0.05). In terms of the size of resection, there were tendencies that the cognitive function is more improved in patients with larger hippocampal resection (>2 cm) and in patients with smaller temporal cortical resection (4 cm). CONCLUSIONS: Patients became seizure free after tailored ATLAH may have improvement in performance IQ and full scale IQ. Right side resection, larger hippocampal resection, and smaller lateral temporal resection show better postoperative cognitive function. (J Korean Neurol Assoc 19(2):116~124, 2001)
Adult ; Anterior Temporal Lobectomy* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Intelligence* ; Memory* ; Seizures ; Temporal Lobe* ; Verbal Learning

We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.
Adenocarcinoma* ; Aged ; Female ; Humans ; Intensive Care Units ; Lung* ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilators, Mechanical ; Erlotinib Hydrochloride

Fungal infection is an uncommon complication after small bowel transplantation. We present a rare form of mucormycosis found in the small bowel graft and in the skin of a recipient. We reviewed chart data and performed MEDLINE searches and found that this case was the first to report 2 kinds of mucormycosis to be found after organ transplantation. The patient was a 12 month old female baby who underwent small bowel transplantation due to short bowel syndrome. After 12 days she experienced acute cellular rejection which responded to steroid. 6 days later due to sustained fever, poor feeding and abdominal distention endoscopic biopsy was done which revealed mucormycosis. Antifungal treatment with lipo-amphotericin B was initiated, yet there was no improvement of clinical symptoms. On the 23 post operative day a black eschar developed on the incision site of the skin and biopsy was done which revealed cutaneous mucormycosis. Infected skin debridement and graftectomy was done but our patient expired because of septic shock.
Biopsy ; Debridement ; Female ; Fever ; Humans ; Mucormycosis ; Organ Transplantation ; Rejection (Psychology) ; Shock, Septic ; Short Bowel Syndrome ; Skin ; Tissue Donors ; Transplants

BACKGROUND: This study aims to report clinical outcome and long term graft and patient survival rate of one thousand kidney transplantation. We analyzed risk factors that impact on graft survival in the 1,000 case of kidney transplantation through this study. METHODS: We have performed 1,000 cases of kidney transplantation in Samsung Medical Center, Seoul, Korea from February 1995 to January 2008. We retrospectively reviewed medical record of recipients and donors. RESULTS: The mean follow up period was 69 months. Composition of type of donor was living donor, 653 cases and deceased donor, 347 cases. Type of donor source was mostly living-related type. 94 cases had graft failure. Major cause of graft failure was chronic allograft nephropathy. And major viral infection was cytomegalovirus infection. Major non-viral infection was urinary tract infection. 47 cases of immediate post operative complication was diagnosed as lymphocele. Overall 10-year graft survival rate was 83.9% respectively. 10-year patient survival rate was 95.7% respectively. 10-year graft survival and patient survival of recipient were significantly different between living donation group and deceased donation group. CONCLUSIONS: In this report, only two risk factor were statically significant difference.
Cytomegalovirus Infections ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Korea ; Living Donors ; Lymphocele ; Medical Records ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tissue Donors ; Transplantation, Homologous ; Transplants ; Urinary Tract Infections

PURPOSE: The purpose of this study was to evaluate the frequency, location, and appearance of increasedattenuation of the liver adjacent to a mass during arterial-phase spiral CT in patients with hemangioma. Thecharacteristics of the mass associated with these findings were also evaluated. MATERIALS AND METHODS: Usingspiral CT, 153 lesions in 114 hepatic hemangioma patients were retrospectively reviewed. We evaluated thefrequency, location, and appearance of increased hepatic attenuation adjacent to the hemangioma, and determinedwhether lesion size varied according to whether or not there was increased hepatic attenuation. RESULTS: Areas ofincreased hepatic attenuation adjacent to the hemangioma were identified in 10.5% of cas-es(16/153) and seen inmasses which showed a homogeneously hyperdense (11/16, 69%) or peripherally hy-perdense pattern (5/16, 31%). Thelocation of increased hepatic attenuation was commonly the peripheral por-tion (9/16, 56%), and increased hepaticattenuation was frequently wedge shaped of the mass (11/16, 69%). Lesion size did not vary according to whether ornot there was increased hepatic attenuation. CONCLUSION: Increased hepatic attenuation adjacent to a hemangiomais not rare, and is usually located periph-eral to the mass. It is common in a mass showing a homogeneouslyhyperdense pattern.
Hemangioma* ; Humans ; Liver* ; Retrospective Studies ; Tomography, Spiral Computed

PURPOSE: Laparoscopic liver resection has gained much popularity in recent years, but relatively few centers have performed hepatectomies in hepatocellular carcinoma (HCC) patients due to the technical difficulties faced with underlying liver cirrhosis. We now present our early experience with laparoscopic liver resection in HCC performed in a single institution. METHODS: From October 2003 until March 2009, 39 laparoscopic liver resections were performed on HCC patients among whom 26 had underlying liver cirrhosis. RESULTS: The location of the tumor was in the left lateral section in 15, segment 5 or 6 in 20, segment 4 in 3 and caudate lobe in 1. Resection involving less than a monosegment was done in 26 and more than 2 segments in 13. Tumor size ranged from 0.8 cm to 6.6 cm (median 2.35) and the resection margin from 0.1 to 6 cm (median 1.5 cm). All patients were either stage I (29) or II (10). There was no difference between cirrhotic and non-cirrhotic patients in operation time (median 210 minutes, range 60~637), change of hematocrit value (4.8%, -1~19.6%), or hospital stay (8 days, 3~67 days). The median follow up duration was 15.1 months, and the 2-year recurrence free survival rate was 48.3%. CONCLUSION: Laparoscopic liver resection in HCC with or without underlying cirrhosis seems to be feasible with minimal morbidity, especially in well selected cases with early stage HCC.
Carcinoma, Hepatocellular ; Fibrosis ; Follow-Up Studies ; Hematocrit ; Hepatectomy ; Humans ; Laparoscopy ; Length of Stay ; Liver ; Liver Cirrhosis ; Recurrence ; Survival Rate

Pulmonary mucormycosis is an opportunistic infection in patients with severe underlying illness such as immunocompromised diseases or uncontrolled diabetes mellitus. While patients with leukemia and lymphoma usually resent with diffuse parenchymal disease, diabetic patients usually have a localized endobronchial disease involving central airways. We report upon a case of pulmonary mucormycosis in diabetes mellitus patient presenting as an endobronchial mass, which was cured with antifungal therapy, rigid bronchoscopic mass removal and right pneumonectomy.
Diabetes Mellitus ; Humans ; Leukemia ; Lymphoma ; Mucormycosis* ; Opportunistic Infections ; Pneumonectomy

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. METHODS: A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveloar lavage or lung biopsy. RESULTS: Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD (3.27±3.15 mg/dl vs. 1.19±0.94 md/dl, p=0.030). The corresponding drop in hemoglobin level was 2.69±1.26 g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by 1.38±4.22 days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). CONCLUSION: The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.
Anemia ; Biopsy ; Collagen ; Cough ; Creatinine ; Diagnosis ; Dyspnea ; Female ; Fever ; Hemoptysis ; Hemorrhage* ; Humans ; Lung ; Lupus Erythematosus, Systemic ; Mortality ; Prognosis ; Radiography, Thoracic ; Retrospective Studies* ; Therapeutic Irrigation ; Thorax ; Vascular Diseases