We report a rare case of multiple intracerebral hemorrhage, subarachnoid hemorrhage, and intraventricular hemorrhage that developed after successful cardiopulmonary resuscitation (CPR). A 66-year-old man underwent CPR for about 10 minutes in his community hospital. At that time, his only sequela was ST depression in leads V3, and V4 with an ECG. There was no definite parenchymal lesion in the brain computed tomography (CT) scan taken in the community hospital, and the patient was transferred to Wonju christian hospital for post-resuscitation management. Upon arrival, echocardiographic findings showed akinesia of the anterior wall and anteroseptal wall together with decreased ejection fraction (34%). A cardiac enzyme assay showed a CK-MB concentration of 19.4 ng/ml and a troponin-I level of 1.66 ng/ml. He was mentally comatose and both pupils were isocoric and reflexive to light. We concluded that the cause of cardiac arrest was acute myocardial infarction (AMI), and the patient was treated with drugs including aspirin, clopidogrel, enoxaparin-sodium (1 mg/kg subcutaneous), and isosorbide dinitrate. At 10 hours after admission, a follow-up ECG showed ST elevation in lead I, aVL and all leads from V1 to V6. Right anisocoria was seen in neurologic examination at that time. A subsequent brain CT revealed multiple intracerebral hemorrhage, subarachnoid hemorrhage into all cisternal spaces, and intraventricular hemorrhage. Clotting evaluations yielded a prothrombin time (PT) of 14.6 sec., partial thromboplastin time (PTT) of 45.3 sec. and an INR of 1.32, and a hemoglobin count of 16.2 g/dL.
Aged ; Anisocoria ; Aspirin ; Brain ; Cardiopulmonary Resuscitation ; Cerebral Hemorrhage ; Coma ; Depression ; Electrocardiography ; Enoxaparin ; Enzyme Assays ; Follow-Up Studies ; Heart Arrest ; Hemoglobins ; Hemorrhage ; Hospitals, Community ; Humans ; International Normalized Ratio ; Intracranial Hemorrhages ; Isosorbide Dinitrate ; Light ; Myocardial Infarction ; Neurologic Examination ; Partial Thromboplastin Time ; Prothrombin Time ; Pupil ; Reflex ; Resuscitation ; Subarachnoid Hemorrhage ; Ticlopidine ; Troponin I

The medial collateral ligament is the most commonly injured ligamentous structure of the knee. The management of the medial collateral ligament injuries were divided into surgical and conservative treatment. More recently, many investigators reported that isolated medial collateral ligament injuries did well under non-operative treatment. So, arthroscopic examination of the knee to rule out other intraarticular pathologic conditions such as cruciate ligament injuries, meniscal tear and osteochondral lesion is essential. From October 1993 to April 1995, we treated 45 cases of Grade III medial collateral ligament injuries and arthroscopic finding for cruciate ligament, meniscus, bony structure were analized in these cases. The result were as follows; 1. Anterior cruciate ligament injury:37.5% in +1 degree, 42.8% in +2 degree, 86.7% in +3 degree 2. Posterior cruciate ligament injury:12.5% in +1 degree, 13.4% in +2 degree, 33.3% in +3 degree 3. Meniscal injury:12.5% in +1 degree, 21.3% in +2 degree, 33.4% in +3 degree 4. Medial capsular ligament injury was more frequent and severe in the meniscofemoral ligament than in the meniscotibial ligament, but that finding was not correlated with degree of medial instability.
Anterior Cruciate Ligament ; Collateral Ligaments ; Humans ; Knee ; Ligaments ; Posterior Cruciate Ligament ; Research Personnel ; Rupture ; Tears

The tonsillolith is a white or yellow colored calcified lesion that forms in the crypts of the palatine tonsil. Small tonsilloliths are frequently found on tonsils, while giant tonsilloliths are a rare clinical entity. We had a 35-years old female patient, who presented throat discomfort due to a giant tonsillolith. The stone was removed and tonsillectomy was performed. We reviewed the literature on this rare clinical entity.
Female ; Humans ; Palatine Tonsil ; Pharynx ; Tonsillectomy

PURPOSE: We compared recipients' ureteral complications after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN). MATERIALS AND METHODS: Between January 1999 and September 2006, a total of 166 transplantaions were underwent via a HALDN or ODN. Kidney transplantation was performed in a standard fashion and ureteroneocystostomy was done by extravesical Lich-Gregoir method. We retrospecitvely compared 2 groups with regard to ureteral complications and functional recovery of transplanted kidney. RESULTS: Twenty-six right kidneys (26/88) were transplanted in HALDN and 20 right kidneys (20/78) were done in ODN. 18 multiple arteries were found in HALDN and 13 in ODN. The mean ischemic time of HALDN and ODN was 270 and 290 seconds. If short length of ureter or anastomosis site swelling was found, ureteral catheter was inserted to ureter of recipient (HALDN: 12, ODN: 3). Four ureteral complications were happened in HALDN group; five in ODN group. In HALDN, two ureteral leakages, one ureteral stricture and one ureteral leakage with anastomosis site narrowing were developed. In ODN, one vesicoureteral reflux, three ureteral leakages and one ureteral stricture were developed. Laterality and multiple renal arteries were not related with ureteral complications. Only ureteral stent insertion reduced ureteral complications (p<0.05). Acute rejection in 1 year were 6 patients in HALDN and 4 patients in ODN. In HALDN, 1-year patient and graft survival was 98.9% (87/88) and 95.5% (84/88); In ODN 100% (78/78) and 98.7% (77/78). CONCLUSIONS: In comparison with ODN, HALDN combined with the extravesical ureteral implantation technique provides similar graft outcomes with low ureteral complication rate. These results suggest that HALDN is safe and effective comparable recipient surgical outcomes.
Arteries ; Constriction, Pathologic ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Nephrectomy ; Rejection (Psychology) ; Renal Artery ; Stents ; Tissue Donors ; Transplants ; Ureter ; Urinary Catheters ; Vesico-Ureteral Reflux

BACKGROUND: Diabetic neuropathy is one of the most common neuropathies. Although pathologic studies show both segmental demyelination and axonal loss in diabetic neuropathy, the relative importance of segmental demyelination is debated. Conduction block (CB) is a physiologic hallmark of segmental demyelination. If segmental demyelination were a main pathology of diabetic neuropathy, CB should be common. We undertook this study to determine the prevalence of CB in diabetic patients. METHODS: Fifty-two consecutive diabetic patients (M=30, F=22) were referred to EMG laboratory and underwent routine nerve conduction studies (NCS). CB was defined by two methods. One was > 20% drop in peak-to-peak amplitude and < 15% change in negative-peak duration between proximal and distal stimulation sites. The other was > 50% drop in the amplitude and area. Clinical findings, electrophysiological data, and effectiveness of immunomodulating therapy for some patients with CB were reviewed. RESULTS: A total 326 nerves were studied. The criteria for 20% and 50% CB were met in 35 nerves in 19 patients and 7 nerves in 6 patients, respectively (prevalence=10.7%, 2.1%, respectively). Some patients with CB were treated with IVIG or steroid and had a good response. CONCLUSIONS: CB in diabetic neuropathy is not a common finding. The rarity of CB in diabetic neuropathy suggests that segmental demyelination is not a prominent part of the underlying pathology. The presence of CB and good responsiveness to immunomodulating therapy in diabetic neuropathy also suggest alternative or additional causes for neuropathy, such as chronic inflammatory demyelinating polyneuropathy.
Axons ; Demyelinating Diseases* ; Diabetes Mellitus ; Diabetic Neuropathies* ; Humans ; Immunoglobulins, Intravenous ; Neural Conduction ; Pathology ; Polyneuropathies ; Prevalence

Signet ring cell carcinoma has been previously described in many organs, most frequently in the stomach, and rarely in the colon, rectum, gallbladder, pancreas, breast, nadsal cavity, prostate, urinary bladder and ureter. Signet ring cell carcinomas in the lung, especially, when examined by small biopsies, are generally believed to be metastatic. This case was diagnosed by bronchoscopic biopsy. We also examined various organs by noninvasive method, including UGI series, barium enema and abdomen CT scarf, but all studies were nomal. Patient received cisplatin and etoposide combination chemotherapy followed by local radiotherapy ai a primary non-small cell lung cancer. Patient died of his disease 6 months after diagnosis. Now we report a case of primary signet ring cell carcinoma of the lung.
Abdomen ; Barium ; Biopsy ; Breast ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Signet Ring Cell* ; Cisplatin ; Colon ; Diagnosis ; Drug Therapy, Combination ; Enema ; Etoposide ; Gallbladder ; Humans ; Lung Neoplasms ; Lung* ; Pancreas ; Prostate ; Radiotherapy ; Rectum ; Stomach ; Ureter ; Urinary Bladder

PURPOSE: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models. METHODS: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models. RESULTS: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed. CONCLUSION: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.
Education ; Herniorrhaphy* ; Humans ; Learning Curve* ; Learning* ; Likelihood Functions ; Retrospective Studies

OBJECTIVE: Serotonin is a neurotransmitter which might play an important role in the pathophysiology of schizophrenia. As atypical antipsychotics, which antagonize serotonin receptors, exert effects on negative symptoms of schizophrenia, perturbation of serotonin system has been thought as a good indicator to probe the pathogenesis of schizophrenia. Serotonin transporter is crucial for regulating serotonergic neurotransmission and has a deletion/insertion polymorphism of the gene's transcriptional initiation site. This study was designed to examine the association of schizophrenia and polymorphism of serotonin transporter gene (5-HTTLPR). METHODS: Genomic DNA analysis with polymerase chain reaction (PCR) was used for genetic typing of polymorphism of 5-HTTLPR. It was carried out among a total of 111 patients with schizophrenia and 208 normal controls. The significances of genetic association of the polymorphisms with the disease and with clinical variables were estimated by chi-square test and analysis of variances. RESULTS: The results were as follows: 1) There were no significant differences in allelic or genotype frequencies between the group of patients with schizophrenia and controls. 2) There were no significant differences in positive syndrome scale score of positive and negative syndrome scale (PANSS), duration of illness and number of admission according to 5-HTTLPR genotypes. 3) There was a difference in age at onset according to 5-HTTLPR genotypes. 4) There was a significant difference in negative syndrome scale score and general psychopathology score of PANSS according to 5-HTTLPR genotypes. CONCLUSION: These results suggest that polymorphism of serotonin transporter gene might be related to the pathophysiology of schizophrenia.
Antipsychotic Agents ; DNA ; Genotype ; Humans ; Neurotransmitter Agents ; Polymerase Chain Reaction ; Psychopathology ; Receptors, Serotonin ; Schizophrenia* ; Serotonin Plasma Membrane Transport Proteins* ; Serotonin* ; Synaptic Transmission

PURPOSE: The purpose of this study was to investigate the incidence of curet fracture and its contributing factors. MATERIAL AND METHODS: Fifty-eight periodontal curets which were broken during periodontal treatment in Kangnung National University Dental Hospital for 1 year were used as study materials. The blade thickness of new curets and broken ones was measured using a digital micrometer. Types of treatment procedures, clinical experience of operators, point of breakage, and method of removal of broken fragments were recorded for each broken curet. RESULTS: The incidence of curet fracture in root planing (16.4 curets per 1,000 procedures) was higher than those in flap surgery (7.5) or supragingival scaling (2.7). No curet was broken during supportive periodontal treatment. The incidence of fracture did not seem to be related with clinical experience of operators. The most frequent breakage point of the curets were upper 1/3 of blades. Fifty-six of 58 broken fragments were removed by non-surgical methods. Two broken tips which could not removed non-surgically were left in the pockets, and proved to be removed spontaneously 1 week later. CONCLUSION: Root planing showed higher incidence of curet fracture than any other type of periodontal treatment. Most of the fractured fragments were removed by non-surgical method. Further study is needed to develop methods of removal of the fragments which can not be removed non-surgically.
Dental Scaling ; Incidence ; Root Planing

PURPOSE: In spite of curative surgery and early postoperative intraperitoneal chemotherapy, the prognosis of patients with gastric cancer involving the serosal surface is poor. The aim of this study was to analyze p53 protein overexpression in these patients and to clarify the usefulness of p53 mutation as a prognostic indicator. METHODS: p53 protein overexpression was assessed by immunohistochemistry in 123 gastric cancer specimens. The correlation between p53 protein overexpression and clinicopathologic parameters and prognosis of the patients were analyzed. RESULTS: Overexpression of p53 protein was identified in 67 (54.5%) tumors and was more frequent in differentiated tumors than in undifferentiated tumors (67.4% vs. 46.8%; P=0.026). However, there were no statistically significant differences in the frequency of p53 protein overexpression according to age, sex, depth of invasion, lymph node metastasis, distant metastasis, pathologic stage, and Lauren classification. There was no statistically significant difference in 5-year survival rate according to the p53 protein overexpression (P=0.565). CONCLUSION: Overexpression of p53 protein could not predict the effectiveness of early postoperative intraperitoneal chemotherapy. Therefore, it could not be used as a prognostic indicator in patients with advanced gastric cancer who underwent gastrectomy and early postoperative intraperitoneal chemotherapy.
Gastrectomy ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms ; Survival Rate ; Tumor Suppressor Protein p53