In complication of infective endocaditis splenomegaly and splenic infarction are not uncommon but splenic rupture is very rare. We report a case of splenic rupture complicated by infective endocarditis in 1 71-yr-old man who had been suffered from rheumatic heart disease (aortic regurgitation and stenosis and mitral regurgitation). The patient was admitted to mild fever and generalized weakness for 20 days. Diagnosis of infective endocarditis due to Staphylococcus epidermidis was made by clinical manifestaions and blood culture study.On 34th day of admissionthe patient suddenly displayed the symptoms and signs of massive intraperitoneal hemorrhage. Splenic rupture was revealed by paracentesis and radiologic studies. Rupture of spleen is an uncommon and usually fatal complication of infective endocarditis. Therefore early diagnosis and prompt treatment must be performed.
Constriction, Pathologic ; Diagnosis ; Early Diagnosis ; Endocarditis* ; Fever ; Hemorrhage ; Humans ; Paracentesis ; Rheumatic Heart Disease ; Rupture ; Spleen ; Splenic Infarction ; Splenic Rupture* ; Splenomegaly ; Staphylococcus epidermidis

No abstract available.
Bone Density* ; Female ; Lactation* ; Postpartum Period*

To clarify possible causes, pathogenesis, and appropriate prevention method of remote intracerebral hemorrhage (RICH), we analyzed the clinical findings and the possible predisposing factors of six cases who developed RICH among the 206 surgical series of cerebral aneurysm operated in our hospital over recent 5-year period. The locations of aneurysm were anterior communicating artery in three cases and internal carotid artery in three other cases. The sites of RICH were dependent regions considering the operative position in five of six cases, con-tralateral cerebellum in three cases, bilateral cerebellum in one case, and contralateral occipital area in one case. Peripheral low density around the RICH, suggesting hemorrhagic infarction, was observed on computed tomography in four cases. No patient had preoperative hypertension; however, significant elevation of blood pressure was observed intraoperatively or postoperatively in three cases. The factors which could have induced brain shift(large amount of removed or drained cerebrospinal fluid, large amount of infused mannitol, too low PaCO2) were observed in all cases except one case. There was no case with coagulopathy or underlying occult lesion. Two patients in whom detection of RICH was delayed showed poor outcomes. The possible underlying mechanisms involved in such complication seem to be shifting of brain due to sudden decreased intracranial pressure and excessive removal of cerebrospinal fluid, and subsequent injury of blood vessels such as compression or breakdown of vein. Moreover, the sudden elevation of blood pressure may have played a role as contributing factor. Therefore, consideration should be given to the maintenance of an adequate volume of intracranial cerebrospinal fluid and the appropriate blood pressure to prevent this complication. Early detection and immediate treatment with awareness of the possibility of this complication should be borne in mind when treating these patients to prevent such complications and to obtain good results.
Aneurysm* ; Arteries ; Blood Pressure ; Blood Vessels ; Brain ; Carotid Artery, Internal ; Causality ; Cerebellum ; Cerebral Hemorrhage* ; Cerebrospinal Fluid ; Hemorrhage ; Humans ; Hypertension ; Infarction ; Intracranial Aneurysm ; Intracranial Pressure ; Mannitol ; Veins

Since introduction of magnetic resonance imaging(MRI), six cases of multiple intracranial meningiomas without signs of neurofibromatosis were found among the forty eight cases of meningiomas. The incidence of multiple intracranial meningiomas in our series was 12.5% of all meningiomas. We analyzed six cases of multiple intracranial meningiomas that were evaluated by MRI. Two tumors were found in five patients, whereas the other one patient had more than ten tumors at different sites. The tendency of unihemispheric distribution was not seen and two cases had bilaterally located tumors and other two cases had tumors above and below the tentorium without tentorial involvement. Relatively high occurrence of meningioma in posterior fossa was observed. Half of the six cases had posterior fossa tumors and 6 tumors(28.6%) of the total 21 tumors were located in the posterior fossa. All the cases were female. Mean age on admission was 61.3 years, ranged from 44 to 77 years. All six patients were treated surgically and three of them underwent multiple staged operations. Histologically, of the 12 tumors removed, 5 were transitional, 4 were fibroblastic, 3 were meningothelial. The histological subtypes of tumors in each case were different in two cases, but identical in other three cases. The surgical results, although the follow-up periods(ranged 3 months to 2.5 years) were not long enough in some cases, were favorable.
Female ; Fibroblasts ; Follow-Up Studies ; Humans ; Incidence ; Infratentorial Neoplasms ; Magnetic Resonance Imaging ; Meningioma* ; Neurofibromatoses

Postoperative acute cholecystitis is a rare complication of orthopaedic surgery and is unrelated to the biliary tract. In particular, in the case of immediate postoperative state after surgery such as kyphoplasty at the thoracic vertebra, symptoms related to inflammation mimic those of abdominal origin, so the diagnosis and the treatment of acute cholecystitis can be delayed leading to a fatal outcome. It is important that physicians should be aware of the postoperative patient's condition in order to make an early diagnosis and determine treatment.
Biliary Tract ; Cholecystitis, Acute ; Early Diagnosis ; Fatal Outcome ; Hydrazines ; Inflammation ; Kyphoplasty ; Spine

In order to compare the amount of surgically induced astigmatism among sutureless group(Group 1),10-0 nylone suture group(Group 2),and using tissue adhesive group(Group 3),we analysed a series of rabbit cataract surgery cases in these three groups. We performed cataract surgery on 30 eyes of 15 rabbits by Irrigation and aspiration technique. After cataract surgery,10 eyes by sutureless technique,10 eyes were closed by conventional 10-0 nylon suture technique, and 10 eyes by tissue adhesive(Beriplast) technique.We collected keratometric data before and after surgery(At 1,2,4,8 weeks).In postoperative astigmatic change,three groups had the distinct features in the evolution for postoperative astigmatism.The group 1 showed early against-the-rule(ATR)astigmatism,which advanced ATR and showed about 0.5D astigmatic change at 8 weeks.The group 2 showed early with-the-rule(WTR)astigmatism about 1.13D,which advanced toward ATR from 1week.The group 3 showed little ATR about 0.2D,which was minimal change in astigmatism.At 8 weeks after operation,there was no signifi-cant difference in the astigmatic change among the three groups(P>0.05), which were no complications observed. In this study,the tissue adhesive(Beriplast)seem to be a simple,effective and less induced astigmatic changing corneoscleral suture technique than other suture techniques
Astigmatism* ; Cataract* ; Nylons ; Rabbits ; Suture Techniques ; Sutures ; Tissue Adhesives*

BACKGROUND: This retrospective study tries to identify specific risk factors that may increase complication rates after the surgical treatment of tuberculous destroyed lung. MATERIAL AND METHOD: A retrospective study was performed on forty-seven patients, who received surgical treatment for tuberculous destroyed lung in the Department of Thoracic and Cardiovascular Surgery at Hanyang University Hospital from 1988 to 1998, to identify specific preoperative risk factors related to postoperative complications. Fisher's exact test was used to identify the correlations between the complications and right pneumonectomy, preoperative FEV1, predicted postoperative FEV1, massive hemoptysis, postoperative persistent empyema. RESULT: Hospital mortality and morbidity rates of the patients who received surgical treatment for tuberculous destroyed lung were 6.4% and 29.7%, respectively. In view of the hospital mortality and morbidity rates as a whole, predicted postoperative FEV1 less than 0.8L(p<0.005), preoperative FEV1 less than 1.8L(p=0.01), massive hemoptysis(p<0.005), postoperative persistent positive sputum cultures(p<0.0005), and the presence of multi drug resistant tuberculosis(p<0.05) presented statistically significant correlations. Among the postoperative complications, bronchopleural fistula, the most common complication, was found to have statistically significant corrleations with the preoperative empyema(p<0.05) and postoperative persistent positive sputum cultures(p<0.05). CONCLUSIONS: Although mortality and morbidity rates after surgical treatment of tuberculous destroyed lung were relatively low, when predicted postoperative FEV1 was less than 0.8L, when preoperative FEV1 was less than 1.8L, when massive hemoptysis was present, when postoperative sputum cultures were persistently positive, and when multi drug resistant tuberculosis was present, the rates were significantly higher.
Empyema ; Fistula ; Hemoptysis ; Hospital Mortality ; Humans ; Lung* ; Mortality* ; Pneumonectomy ; Postoperative Complications ; Retrospective Studies ; Risk Factors* ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: The indications and the optimal time of surgery of infective endocarditis are controversial. We report the surgical results of our hospital during the last 10 years with literature review. MATERIAL AND METHOD: Between January 2000 and December 2009, we enrolled 23 infective endocarditis patients who underwent surgery, and analyzed retrospectively. In the preoperative blood culture, 8 cases (34.8%) were positive. The average preoperative antibiotics treatment period was 20.78+/-16.00 days. There were 12 (52.2%) urgent operations. The average follow up period was 49.26+/-33.21 months. RESULT: 20 mechanical valve replacements were performed, 9 in aortic position, 8 in mitral position and 3 in the both positions. The other procedures were one mitral valvuloplasty, one infected myxoma extirpation, and one infected pacemaker lead removal with debridement. The average period of postoperative intravenous antibiotic treatment was 24.39+/-15.98 days. There were 5 complications, including 2 cases of postoperative bleeding, one postcardiotomy syndrome, one cerebral ischemia, and a low cardiac output syndrome. There were statistically significant postoperative improvement in NYHA class, left ventricle end diastolic/end systolic volume, and left atrium size (p-value<0.05). CONCLUSION: We could obtain the satisfactory results without any mortalities by using sufficient preoperative antibiotics in hemodynamically stable patients, and by prompt surgery in unstable patients.
Anti-Bacterial Agents ; Brain Ischemia ; Cardiac Output, Low ; Debridement ; Endocarditis ; Follow-Up Studies ; Heart Atria ; Heart Valve Diseases ; Heart Ventricles ; Hemorrhage ; Humans ; Myxoma ; Retrospective Studies

Background: This study explored the effect of anger on suicidality by dividing participants into a group with major depressive disorder (MDD) and a non-MDD group, and also investigated whether the anger expression affects suicidality in participants without clinical depression. Methods: A total of 1,015 residents responded to anonymous questionnaires in our survey. The survey included scales, such as the Patients Health Questionnaire-9 (PHQ-9), Korean State-Trait Anger Expression Inventory, and Mini-International Neuropsychiatric Interview-Plus. Participants were categorized into the MDD and non-MDD groups or depression group and non-depression group following the PHQ-9 score. Logistic regression analysis was performed to confirm the association between anger and suicidality in the non-MDD and non-MDD groups. Results: Anger suppression and higher PHQ-9 appeared as risk factors for suicidality in the non-MDD group. The depression level in the non-MDD group mediates the relationship between anger suppression and suicidality. Higher PHQ-9 was no longer a risk factor and anger suppression remains a risk factor in the non-depression group. Conclusion Not only depression evaluation, but also anger evaluation is important when assessing suicidality. Implementing anger management programs for people with high anger suppression can help lower suicidality in Korean society, where negative emotional expression is suppressed.

PURPOSE: The aims of this study were to examine the methylation status of the p16 and MGMT promoters in hepatocellular carcinoma (HCC), and to evaluate the relationship between the loss of gene expression, the promoter methylation status and hepatocarcinogenesis. METHODS: We included 24 HCC tissues and their adjacent non-tumorous tissues and 5 normal liver tissues in our study, and all the specimens were obtained by hepatectomy. The methylation status of the p16 and MGMT promoter regions were evaluated by methylation-specific polymerase chain reaction (MSP) and quantitative analysis by using a Gel-pro analyzer (Media Cybernetics, CA, USA). We also analyzed the p16 and MGMT gene expressions by performing immunohistochemical staining of the HCC tissues. RESULTS: Methylation of the p16 promoter was detected in HCC (100%, 24/24) and the adjacent non-tumorous tissues (79.2%, 19/24), but not in the normal liver tissues. Methylation of the MGMT promoter was detected in the HCC (8.3%, 2/24) and the adjacent non-tumorous tissues (4.2%, 1/24), but not in the normal liver tissues. Methylation positive HCC samples showed the loss of p16 expression in 58.3% (14/24). The loss of the p16 expression in the HCC tissues was well correlated with the increased rate of p16 promoter methylation (p=0.009). When the p16 promoter methylation status of the HCC tissues was higher than that of the adjacent non-tumorous tissues, 77.8% of the cases showed the loss of the p16 expression (p=0.002). No correlation was observed between MGMT promoter methylation and the loss of the gene expression in the HCC tissues. CONCLUSION: These results suggest that methylation of the p16 promoter and the resulting loss of p16 protein expression are significant events in hepatocarcinogenesis, and further studies are needed to evaluate the relationship between the methylation of the MGMT promoter and HCC carcinogenesis.
Carcinogenesis ; Carcinoma, Hepatocellular* ; Cybernetics ; Gene Expression ; Hepatectomy ; Liver ; Methylation* ; Polymerase Chain Reaction ; Promoter Regions, Genetic