PURPOSE: Computed tomography (CT) is the standard diagnostic method employed in cases of blunt head trauma, and repeat CT (RCT) scans are very often obtained in order to monitor for acute progression of intracranial pathology. The purpose of this study was to retrospectively evaluate the utility of the routine RCT scans in patients with traumatic brain injury (TBI), and to suggest the guidelines for RCT scans of the head. METHODS: The trauma registry and medical records of patients who were admitted to the emergency department of our university hospital from January 2004 to December 2006 were retrospectively reviewed. All patients admitted with TBI who received RCT scans of head were enrolled in this study. Results of initial head CT scans, indications for RCT (routine vs. neurologic change), and neurosurgical interventions (craniotomy and extraventricular drainage) were recorded. For patients who received worsened or unchanged subsequent RCT scans, the scans were compared and independent predictors of a worsened RCT were identified by stepwise logistic regression. Patients were categorized according to the Glasgow Coma Scale (GCS) as having mild (GCS 14-15), moderate (GCS 9-13), or severe (GCS< or =8) head injury. RESULTS: All inclusion criteria were met in 338 patients. Most (70.7%, n=239) RCT scans were preformed on a routine basis, whereas 29.3% (n=99) were ordered in response to neurological change. One hundred eleven (32.8%) patients showed signs of worsening on RCT, and 62 (13.8%) required neurosurgical intervention. Risk factors associated with worsening on CT evaluations were coagulopathy; skull fracture; multiple lesions; and an initial diagnosis of acute subdural hematoma, acute epidural hematoma, or hemorrhagic contusion. No patient with a mild or moderate TBI without neurological deterioration underwent an neurosurgical intervention after routine RCT. However, of the 48 patients with severe TBI who underwent routine RCT, the repeat scanning led to neurosurgical intervention in 5 patients (10.4%). CONCLUSION: In patients with mild and moderate TBI without clinical deterioration, routine RCT does not alter management and is unnecessary. Nevertheless, conclusions about patients with moderate TBI should be drawn with caution. Routine RCT is unequivocally indicated for patients with severe TBI, because the results sometimes dictate neurosurgical intervention even in the absence of obvious neurological deterioration.
Brain Injuries* ; Brain* ; Contusions ; Craniocerebral Trauma ; Diagnosis ; Emergencies* ; Emergency Service, Hospital ; Glasgow Coma Scale ; Head ; Hematoma ; Hematoma, Subdural, Acute ; Humans ; Logistic Models ; Medical Records ; Pathology ; Retrospective Studies ; Risk Factors ; Skull Fractures ; Tomography, X-Ray Computed

A novel glucanhydrolase from Lipomyces starkeyi KSM 22 has been suggested as a promising anti-plaque agent because it has been shown to have additional amylase activity and mutanase activity besides dextranase activity and to strongly bind to hydroxyapatite. Mouthrinsing with Lipomyces starkeyi KSM 22 glucanhydrolase solution was comparable to 0.12% chlorhexidine mouthwash in inhibition of plaque accumulation and gingival inflammation and local side effects were less frequent and less intense in human experimental gingivitis. In this study, Lipomyces starkeyi KSM 22 glucanhydrolase mouthrinses (1 and 2 unit/ml) were compared with a control mouthrinse (commercial 0.01% benzethonium chloride mouthrinse, Caregargle(R), Hanmi Pharmaceuticals) in the ability to inhibit plaque formation. A 3-replicate clinical trial using 4-day plaque regrowth model was used. Fifteen volunteers were rendered plaque-free on the 1st day of each study period, ceased toothcleansing, and rinsed 2X daily with allocated mouthrinse thereafter. On day 5, plaque accumulation was scored and the washout periods was 9 days for the next trial. Lipomyces starkeyi KSM 22 glucanhydrolase(1 unit and 2 unit)- containing mouthrinse resulted in significantly lower plaque formation in plaque area and thickness, compared to the control mouthrinse. There was no significant difference in plaque inhibition between enzyme-mouthrinses at 2 different concentrations used. This glucanhydrolase- containing mouthwash resulted in significantly lower plaque area severity index score and tended to have lower plaque thickness severity index score than those of control mouthrinse. But there was no significant difference according to the enzyme concentration. From these results, Lipomyces starkeyi KSM 22 glucanhydrolase-containing benzethonium chloride mouthrinse has greater anti-plaque effect than the commercial mouthrinse alone. Therefore this glucanhydrolase preparation is a promising agent for new mouthwash formulation in the near future.
Amylases ; Benzethonium ; Chlorhexidine ; Dextranase ; Durapatite ; Gingivitis ; Humans ; Inflammation ; Lipomyces* ; Volunteers

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) has become firmly established as an effective mode of renal replacement therapy. The purpose of this study was to understand the clinical courses in stable CAPD patients. METHODS: Fifty-four patients were analyzed with residual renal function (RRF), adequacy of dialysis (such as weekly Kt/V), urine volume, normalized protein catabolic rate (nPCR), serum albumin and dialysate CA125. We retrospectively compared the changes of several indices at mean 5.8 months and mean 31.3 months after initiation of CAPD. RESULTS: During CAPD, body weight was significantly increased (59.6+/-10.9 vs. 62.7+/-10.6 kg, p < 0.01: 2.9 kg/year) but RRF (2.61+/-2.78 vs. 2.02+/-2.73 mL/min, p < 0.05) were significantly decreased with time. Higher RRF group showed higher nPCR (1.07+/-0.36 vs. 0.89+/-0.15 g/kg/day, p < 0.01) and higher weekly Kt/V (2.49+/-0.66 vs. 1.97+/-0.40, p < 0.01). DM group showed lower dialysate CA125 (17.34+/-6.83 vs. 28.03+/-19.08 U/mL, p < 0.05) and lower serum albumin. From the beginning, hypoalbuminemic patients showed higher 4hr (D/P)Cr (0.68+/-0.11 vs. 0.59+/-0.12, p < 0.05). Serum albumin was negatively correlated with 4hr (D/P)Cr (r=-0.308, p=0.008). CONCLUSION: Stable CAPD patients showed weight gain and decrement of RRF with time. And better RRF group showed better clinical indices (nPCR, wKt/V). We can conclude that maintaining of RRF will be important to keep better clinical courses of CAPD patients. Further study (including effect of peritonitis) will be necessary to evaluate the clinical courses of CAPD patients.
Body Weight ; Diabetes Mellitus ; Dialysis ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Replacement Therapy ; Retrospective Studies ; Serum Albumin ; Weight Gain

BACKGROUND AND OBJECTIVES: The effects of estrogen in the myocardium of aged ovariectomized rats, relating to the estrogen replacement onset time following an ovariectomy, and the replacement duration have not yet been established. The object of this study was to investigate the effects of estrogen replacement in the myocardium of aged ovariectomized rats. MATERIALS AND METHODS: 52 Female Sprague Dawley rats, about 3 months old, were subjected to sham surgery only (Group 1 ; control, n=9) ; a bilateral ovariectomy (OVX) and maintained untreated for a period of 12 weeks following surgery (Group 2 ; OVX only, n=16) ; estrogen conjugate 25 microgram/kg daily for 4weeks from the 8th post ovariectomy week (Group 3 ; OVX+estrogen replacement therapy : ERT 4weeks, n=10) ; estrogen conjugate 25 microgram/kg daily p.o for 12weeks directly post ovariectomy (Group 4 ; OVX+ERT 12weeks, n=17). We measured the left ventricular wall thickness (LVWT), the number of cardiomyocytes and interstitial fibrosis, edema, using light and electron microscopy. RESULTS: The LVWT in group 4 was 2.25 mm, which was significantly decreased compared to groups 2 and 3, which were 2.45 mm (p=0.014) and 2.46 mm (p=0.008), respectively. The LVWT in group 4 was not significantly different to that of group 1. Interstitial edema was significantly decreased in group 4 (41.2%) compared to that of group 3 (62.0%) (p=0.019). The electron microscopic findings showed a decrease of crystae and a loss of matrix, resulting in a whitish discoloration of the mitochondria in groups 2 and 3. A similar finding was not observed in groups 1 and 4. CONCLUSION: These results suggest that early administration and maintenance of estrogen following a bilateral ovariectomy could prevent the myocardial changes caused by estrogen deficiency.
Animals ; Edema ; Estrogen Replacement Therapy ; Estrogens* ; Female ; Fibrosis ; Humans ; Hypertrophy ; Infant ; Microscopy, Electron ; Mitochondria ; Myocardium* ; Myocytes, Cardiac ; Ovariectomy ; Rats* ; Rats, Sprague-Dawley

OBJECTIVE: This study was designed to evaluate the ultrasonographic (US) findings of medullary thyroid carcinoma (MTC) as compared to findings for papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: The study included 21 cases of MTC that were surgically diagnosed between 2002 and 2007 and 114 cases of PTC that were diagnosed in 2007. Two radiologists reached a consensus in the evaluation of the US findings. The US findings were classified as recommended by the Thyroid Study Group of the Korean Society of Neuroradiology and Head and Neck Radiology (KSNHNR) and each nodule was identified as suspicious malignant, indeterminate or probably benign. The findings of medullary and papillary carcinomas were compared with use of the chi-squared test. RESULTS: The common US findings for MTCs were solid internal content (91%), an ovoid to round shape (57%), marked hypoechogenicity (52%) and calcifications (52%). Among the 21 cases of MTC nodules, 17 (81%) were classified as suspicious malignant nodules. The mean size (longest diameter) of MTC nodules was 19 +/- 13.9 mm and the mean size (longest diameter) of PTC nodules was 11 +/- 7.4 mm; this difference was statistically significant (p < 0.05). An ovoid to round shape was more prevalent for MTC lesions than for PTC lesions (p < 0.05). CONCLUSION: The US criteria for suspicious malignant nodules as recommended by the Thyroid Study Group of the KSNHNR correspond to most MTC cases. The US findings for MTC are not greatly different from PTC except for the prevalence of an ovoid to round shape.
Adult ; Aged ; Calcitonin/blood ; Carcinoma, Medullary/*ultrasonography ; Carcinoma, Papillary/*ultrasonography ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Thyroid Neoplasms/*ultrasonography

BACKGROUND: Bronchial asthma is a clinical syndrome characterized by reversiblity of airway obstruction. however, many asthma patients have evidence of residual airway obstruction. It has become evident that the repair of chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characterics in asthma patients with emphysema. METHODS: We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups: Asthma patients with and without emphysema. RESULTS: Of the 58 patients, 7 were judged to have emphysema. (1) 6 asthma patients with emphysema were smokers, but one patient was nonsmoker. (2) Highly significant differences between patients with and without emphysema were found in cigarette smoking (p<0.01), smoking consumption (p<0.01). (3) There was no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There was no significant differences in FEV1 (%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%), DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickening (p<0.05) and in total Ig E (p=0.07). CONCLUSION: These results indicate that smoking is a main factor to cause emphysema in the patient with asthma.
Airway Obstruction ; Asthma* ; Asthma, Exercise-Induced ; Carbon Monoxide ; Emphysema* ; Humans ; Mediastinal Emphysema ; Respiratory Function Tests ; Smoke ; Smoking ; Thorax ; Tomography, X-Ray Computed

BACKGROUND: Bronchial asthma is a clinical syndrome characterized by reversiblity of airway obstruction. however, many asthma patients have evidence of residual airway obstruction. It has become evident that the repair of chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characterics in asthma patients with emphysema. METHODS: We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups: Asthma patients with and without emphysema. RESULTS: Of the 58 patients, 7 were judged to have emphysema. (1) 6 asthma patients with emphysema were smokers, but one patient was nonsmoker. (2) Highly significant differences between patients with and without emphysema were found in cigarette smoking (p<0.01), smoking consumption (p<0.01). (3) There was no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There was no significant differences in FEV1 (%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%), DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickening (p<0.05) and in total Ig E (p=0.07). CONCLUSION: These results indicate that smoking is a main factor to cause emphysema in the patient with asthma.
Airway Obstruction ; Asthma* ; Asthma, Exercise-Induced ; Carbon Monoxide ; Emphysema* ; Humans ; Mediastinal Emphysema ; Respiratory Function Tests ; Smoke ; Smoking ; Thorax ; Tomography, X-Ray Computed