449 hospital patients with no pathologic brain CT findings, 30 yrs of age or older, were selected for the study of cerebral atrophy during the 30 months, from January 1980 to June 1983, at dept. of internal medicine, Hanyang Univ. hospital & following results were obtained. 1) Thoses in male group, A gradually progressive increase in the degree of cerebral atrophy score in the 3rd, 4th & late 5th decades was followed by a dramatic increase in the late 6th & 7th decades. 2) Those in female group, A gradually progressive increase in the degree of cerebral atrophy.
Atrophy* ; Brain* ; Female ; Humans ; Internal Medicine ; Male

449 hospital patients with no pathologic brain CT findings, 30 yrs of age or older, were selected for the study of cerebral atrophy during the 30 months, from January 1980 to June 1983, at dept. of internal medicine, Hanyang Univ. hospital & following results were obtained. 1) Thoses in male group, A gradually progressive increase in the degree of cerebral atrophy score in the 3rd, 4th & late 5th decades was followed by a dramatic increase in the late 6th & 7th decades. 2) Those in female group, A gradually progressive increase in the degree of cerebral atrophy.
Atrophy* ; Brain* ; Female ; Humans ; Internal Medicine ; Male

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 AND OBJECTIVES: Otogenic cerebrospinal fluid (CSF)fistula referrs to the abnormal communication between the CSF and the middle ear space due to defects in the inner ear, and is one of the causes of recurrent meningitis. MATERIALS AND METHODS: We report on five children with congenital otogenic CSF fistula, presented by recurrent meningitis and confirmed by surgical exploration. We also propose diagnostic steps for detecting otogenic fistula in the children based on our experiences and paper review. RESULTS: We used the metrizamide CT in the diagnostic procedure for most cases, although not all. The temporal bone CT was an useful initial diagnostic step for clinically suspicious cases. CONCLUSION: No one test or combination of specific tests were found to accurately predict the presence or absence of CSF fistula. It is thought that the only way to diagnose the CSF fistula is by surgical exploration. If the CSF fistula was suspected, aggressive diagnostic evaluation was needed in order to prevent recurrence.
Cerebrospinal Fluid ; Child* ; Diagnosis* ; Ear, Inner ; Ear, Middle ; Fistula* ; Humans ; Meningitis* ; Metrizamide ; Recurrence ; Temporal Bone

Endovascular repair with covered stents has been widely used to treat subclavian and axillary artery injuries and has produced promising early results. The possibility of a thromboembolism occurring in cerebral arteries during an endovascular procedure should be a cause for concern. In the case of endovascular management of arterial traumas, a prompt and sufficient period for check-up of the patient's neurological signs is needed, even if it requires postponing elective intervention for the patient's safety. We report a rare case of liver transplantation immediately after endovascular repair of an iatrogenic subclavian arterial injury to describe the risk of continuing planned surgery without neurologic assessment.
Axillary Artery ; Cerebral Arteries ; Cerebral Infarction ; Endovascular Procedures ; Liver Transplantation ; Stents ; Subclavian Artery* ; Thromboembolism

The hysteroscope has become a standard part of gynecologists' armamentarium, and hysteroscopy is taught routinely in residency curriculums. In recent years, its use in gynecology has changed from a diagnostic tool only to an instrument for gynecologic operations. An electrolyte-free irrigation fluid is used for hysteroscopic surgery, and it has a possibility of substantial absorption of irrigation fluid. The absorption depends on the rate, volume and nature of the irrigation fluid. Fortunately, large-scale fluid absorption is rare but leads to symptoms severe enough to require intensive care. Several methods have been proposed to reduce the risk but none of them is capable of preventing the complication from fluid absorption. In this case, the patient had pulmonary interstitial edema with hyponatremia after hysteroscopic uterine septectomy but that had resolved without sequelae.
Absorption ; Curriculum ; Edema ; Gynecology ; Humans ; Hyponatremia ; Hysteroscopes ; Hysteroscopy ; Intensive Care ; Internship and Residency ; Pulmonary Edema

T cell immunity and phagocytic activity were studied in the blood of patients with IgA nephropathy in order to clarify their roles in the pathogenesis of IgA nephropathy. The percentages of total T lymphocytes, helper T cell and suppressor T cells were significantly reduced in patients. A significantly elevated helper T cell/suppressor T cell ratio in patients showed a predominant reduction in suppressor T cells. There was a significant relationship between histologic findings and helper T cell/suppressor T cell ratio in patients. Natural Killer (NK) cell activity was significantly reduced but the lymphocyte response after phytohemagglutinin (PHA) stimulation was not in patients. ConA-induced suppressor cell activity was not depressed despite of a decrease in suppressor T cells in patients. Phagocytic activity of polymorphonuclear leucocytes (PMNs) ingesting yeasts was significantly reduced in patients. Also an inverse correlation was found between serum IgA levels and phagocytic activity of PMN. It is concluded that suppressor T cell defects, depressed phagocytic activity and impaired NK cell activity may play a role in the pathogenesis of IgA nephropathy.
B-Lymphocytes/immunology ; Glomerulonephritis, IGA/*immunology/pathology ; Humans ; Killer Cells, Natural/immunology ; Neutrophils/immunology ; *Phagocytosis ; T-Lymphocytes/*immunology ; T-Lymphocytes, Regulatory/immunology

BACKGROUND AND OBJECTIVES: Transient evoked otoacoustic emission (TEOAE) has an increasingly signficant role in pediatric otological practice such as screening hearing in newborn babies. To assess the potential applicability of the TEOAE measurements on the sequential monitoring of pediatric patients with middle ear effusion (MEE), we investigated the effects of MEE on the TEOAE responses. MATERIALS AND METHODS: TEOAE responses were recorded from 33 patients (56 ears) before and after ventilation tube insertion. RESULT: In the 37 cases with MEE, we found that the average band reproducibility below 2 kHz was recovered significantly after the tube placement, although the band reproducibility at 5 kHz was diminished. In the 19 cases without MEE, no significant changes in echo amplitude and band reproducibility were noted in the postoperative TEOAE measurements compared to the preoperative measurements. CONCLUSION: The results of this study suggest that an improvement in echo response and band reproducibility less than 2 kHz in serial TEOAE measurements may indicate the resolution of MEE in children with OME.
Child ; Hearing ; Humans ; Infant, Newborn ; Mass Screening ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Ventilation

In the pediatric ICU and operating room, a central venous catheter (CVC) provides accurate hemodynamic information and serves as a reliable route for the administration of vasoactive drugs, fluids and allogeneic blood products. The placement of CVC is associated with a complication rate of 0.4% to 20%, including hemothorax, pneumothorax, thrombosis, infection and cardiac tamponade. We describe a case of CVC being misplaced in the innominate vein after penetrating the subclavian vein during anesthesia induction for arterial switch operation. Our report discusses the mechanisms by which this mishap took place, and reviews the proper positions of the head, arm, thorax and safe depth of venipuncture for the placement of a CVC in neonates.
Anesthesia ; Arm ; Brachiocephalic Veins ; Cardiac Tamponade ; Central Venous Catheters ; Head ; Hemodynamics ; Hemothorax ; Humans ; Hypogonadism ; Infant, Newborn ; Mitochondrial Diseases ; Operating Rooms ; Ophthalmoplegia ; Phlebotomy ; Pneumothorax ; Subclavian Vein ; Thorax ; Thrombosis

BACKGROUND: Remifentanil is a useful opioid, but it induces postoperative hyperalgesia and acute tolerance associated N-methyl-D-aspartate (NMDA) receptor. This study was aimed to investigate whether small dose ketamine, NMDA receptor antagonist, prevent remifentanil induced postoperative hyperalgesia or acute tolerance after combined anesthesia with propofol and remifentanil using target controlled infusion (TCI) in patients undergoing mastectomy. METHODS: Fourty ASA physical status 1 or 2 women, undergoing mastectomy were randomly assigned to two groups to receive intraoperative infusion of ketamine at 3microgram/kg/min rate after injection of ketamine 0.3 mg/kg as a loading dose (Group K) or saline infusion after saline loading at the same rate and dose (Group C). All the patients were anesthetized with propofol and remifentanil to maintain bispectral index (BIS) 40-60, mean arterial pressure within 20% of basal values. Remifentanil was infused with target controlled infusion (TCI) to the effect site (concentration: 2.0 ng/ml). Postoperative paine scores (visual analog scale: VAS), morphine requirements, and sedation scores were recorded for 48 hours postoperatively. RESULTS: The VAS scores and morphine requirements of the Group K were significantly lower than those of the Group C at the postanesthetic care unit and at the ward for 24 hours postoperatively. The extubation time was delayed in Group K compared with Group C. CONCLUSIONS: Intraoperative infusion of small dose ketamine reduced postoperative pain and morphine requirements after combined anesthesia with propofol and remifentanil in patients undergoing mastectomy.
Anesthesia ; Arterial Pressure ; Female ; Humans ; Hyperalgesia ; Ketamine ; Mastectomy ; Morphine ; N-Methylaspartate ; Pain, Postoperative ; Piperidines ; Propofol