BACKGROUND AND OBJECTIVES: Recurrent vestibulopathy is defined a disease characterized by more than a single episode of vertigo of duration characteristic of endolymphatic hydrops but without auditory or clinical neurological symptoms or signs. To investigate the clinical characteristics and the efficacy of combination therapy, we analyzed the clinical records of the patients diagnosed as recurrent vestibulopathy. MATERIALS AND METHOD: Clinical records of sixty four patients diagnosed as recurrent vestibulopathy were retrospectively reviewed. The data on age, sex distribution, natural history, family history of recurrent vestibulopathy, concurrent headache, caloric response was analyzed. The efficacy of combination therapy for vertigo control in the patients with a minimum 24-month follow-up was also evaluated. RESULTS: Mean onset age of recurrent vestibulopathy was 43 years and there was a female preponderance. Concurrent headache and elevated SP/AP ratio in electrocochleogram was frequently observed in these patients. After the combination medical therapy, patients with severe recurrent vestibulopathy showed significant decrease in the number of vertigo spells with 37.5% of complete control of vertigo. CONCLUSION: As a distinctive clinical disorder with unknown cause, recurrent vestibulopathy should be always considered to the patients complaining recurrent episodic vertigo. Combination therapy individualized to the symptoms and signs of the patients with recurrent vestibulopathy might be effective in reducing the frequency of vertigo attacks. Further case-control studies with large population should be necessary.
Age of Onset ; Case-Control Studies ; Endolymphatic Hydrops ; Female ; Follow-Up Studies ; Headache ; Humans ; Natural History ; Retrospective Studies ; Sex Distribution ; Vertigo ; Vestibular Neuronitis*

It is well recognized that there is an association between hyperlipidemia and pancreatitis. However, it is not so easy to define clearly whether lipid abnormalities are the cause or the result of pancreatitis. Generally, a serum level of more than 1,000 mg/dL of triglyceride is an identifiable risk factor of hyperlipidemic pancreatitis in patients with type I, IV, or V hyperlipidemia classified by Fredrick's criteria. The clinical course as well as the management of hyperlipidemic pancreatitis is not different from that of pancreatitis of other causes. A thorough family history of lipid abnormalities should be obtained and an attempt to identify secondary causes should be made. The mainstay of treatment includes dietary restriction of fat and lipid-lowering medications. In Korea, there have been reported several cases of hyperlipidemic pancreatitis but familial history of hyperlipidemia has never been identified. We experienced a case of acute type IV hyperlipidemic pancreatitis in a patient suspected of familial combined hyperlipidemia. So, we report this case with the review of related literature.
Humans ; Hyperlipidemia, Familial Combined* ; Hyperlipidemias ; Korea ; Pancreatitis* ; Risk Factors ; Triglycerides

PURPOSE: The 2005 guidelines for cardiopulmonary resuscitation (CPR) caution that effective compression is essential (Class I) and chest compression (CC) by rescuers should be switched every 2 minutes to avoid rescuer's fatigue. It is controversial how long effective CC by a single individual can be provided. There are few reports about CPR quality, especially when rescuers perform CC for more than 10 minutes. The mean CPR period was about 30 minutes in Korea. We investigated the quality of CC and rescuer's fatigue after about 30 minutes. METHODS: From April 2009 to July 2009, health care providers (HCPs) were recruited into this study. The study simulated 2 person, in-hospital CPR. On the test day, which had been randomly assigned, each participant performed 7 CCs for about 30 minutes. The period of each CC was 2 minutes, and the period of each circulation check was 5 seconds. Participants' heart rates (HR) and visual analogue scale (VAS) scores for fatigue were obtained before and after each CC. Data for each 2 minutes CC was obtained with the use of Resusci Anne(R) with the Laerdal(R) PC skill reporting system. We used one-way repeated measures ANOVA for comparison of quality and fatigue of each CC and multiple linear regression for finding the predictors for correct CC. SPSS 17.0 was used for analysis. RESULTS: Among a total of 30 HCPs, data from 27 were analyzed. All participants were certified as a BLS provider and some were certified as BLS instructors. The rate of effective compression was 83.8+/-24.3%. Despite 2 min CC tasks were repeated alternatively for about 30 minutes, there were no differences in the number of correct CCs, depth and velocity of compression, and the number of incorrect CCs. CONCLUSION: During in-hospital CPR, HCPs may provide effective chest compressions on shifts with minimal effect of fatigue, even if they provide CC for 30 minutes.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Rate ; Humans ; Korea ; Linear Models ; Manikins ; Thorax

A 41-year-old female complaining of easy fatigue, headache, thickened extremities and deepened facial folds was admitted to the hospital. As early as 6 years ago, she had been told by family members that her voice was changed and both hands was thickened. Cranial plain radiography indicated ballooning of sella turcica. Sella MRI disclosed 2.2cm sized pituitary tumor with suprasellar extension. The pituitary tumor with hypothalamic extension was removed via a transsphenoidal approach. The postoperative course was uneventful until hyponatremia with sudden headache and respiratory arrest was developed. The case was due to hyponatremic encephalopathy on the basis of the clinical course and symptoms, and 3% hypertonic saline was infused for 12 hours until the hyponatremia was corrected. We have experienced a mortality case of hyponatremic encephalopathy in which surgieal removal of a pituitary tumor from a female acromegalic patient in menstruant period was followed by the sudden occurrence of hyponatremia, which in turn was later associated with marked brain edema.
Adult ; Brain Edema ; Extremities ; Fatigue ; Female ; Hand ; Headache ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Mortality ; Pituitary Neoplasms ; Radiography ; Sella Turcica ; Voice

Although dissecting aneurysm of vertebral artery were once thought to be extremely rare, they are now recognized with increasing frequency by dint of aggressive work-up using sophisticated imaging techniques. Vertebral dissection most commonly result from cervical hyperextension and lateral cervical rotation. Our two cases followed suit respectively and presented with ischemic symptoms. The vertebral angiogram demonstrated a pseudoaneurysm at the site of dissection in both cases. Presence or absence of SAH, size of dissection and incorporation of the PICA into dissection greatly have influence upon the outcome after treatment. The authors report two cases of dissecting aneurysm of vertebral artery, in which complete resolution of the pseudoaneurysm was spontaneously achieved following conservative management.
Aneurysm, Dissecting* ; Aneurysm, False ; Pica ; Vertebral Artery*

BACKGROUND: Varix bleeding in children is infrequent but it is potentially fatal. It has characteristics different from adult age varix bleeding. But there was little clinical data about it. The purposes of this study is to detect its characteristics of varix bleeding in pediatric patients, and to help an emergency physician make a decision about the management. METHODS: We reviewed medical records of 32 patients who visit Seoul National University Hospital Pediatric Emergency center from Jan. 1, 1995 to Dec. 31, 1996. RESULTS: 1) The peak age was between 1 and 5 years of age, and the ration of males to females was 1: 1. 2) As a underlying cause, intrahepatic disease were more common than extrahepatic diseases(87.1%:12.9%). 3) 10 patients(31.3%) had URI symptoms as a precipitating factor. 4) Varix bleeding has a circardian rhythm, and occured more often during the night. 5) In Child Classification for the hepatic reserve fuction, Child C was the most common(75%). 6) Endoscopic eliminations were performed in 14 patients(43.8%). 7) According to shock classification. the ration of conservative to vasopressin treatment in class I and class II were 13(40.6%)/10(31.3%) and 6(18.8%)/3(9.4%), respectively. 8) Fever was the most common complication(43.8%), and the mortality rate was 3.1%. CONCLUSION: We suggest that the only conservative management can show a good result far pediatric varix bleeding compared to other treatment modalities.
Adult ; Child ; Classification ; Emergencies* ; Esophageal and Gastric Varices* ; Female ; Fever ; Hemorrhage* ; Humans ; Male ; Medical Records ; Mortality ; Precipitating Factors ; Seoul ; Shock ; Varicose Veins ; Vasopressins

BACKGROUND: Inflammatory mediators, including oxidants, play a important role in the systemic response to burn injury and cause a sepsis and subsequent multiple organ failure by lipid peroxidation of cell. It has been known that vitamin C has potent antioxidant effect and inhibits the lipid peroxidation. This study was designed to evaluate the inhibitory effect of vitamin C about lipid peroxidation in the early stage of bum injury. METHODS: 15 rats with second degree bum on 30-35% of body surface were divided into three groups. Only normal saline was injected into intraperitonial space on the control group , and vitamin C of 50 mg/kg of body weight was added on the low dose group (LDG), and vitamin C of 500 mg/kg of body weight on the high dose group (HDG). After 24 hours of bum damage, biochemical levels of malondialdehyde (MDA), superoxide dismutase (SOD) and catalase were measured in lung and liver tissue. The statistical methods used were Kruskal-Wallis test and Mann-Whitney test. RESULTS: MDA levels of LDG and HDG were significantly low compared to that of the control group (p<0.01). On the catalase activity, there was no significant difference when comparing the control group with LDG (p=0.015), but significant difference with HDG (p<0.01). There was no significant differences between three groups on the activities of SOD (p>0.01), except comparing the control group with HDG in lung tissue (p<0.01). CONCLUSION: Vitamin C therapy in the early stage of bun decreased the level of MDA and increased the catalase activity. It means that vitamin C inhibits the lipid peroxidation and has antioxidant effect. But vitamin C revealed the only partial effect on the SOD activity.
Animals ; Antioxidants* ; Ascorbic Acid* ; Body Weight ; Burns* ; Catalase ; Lipid Peroxidation ; Liver ; Lung ; Malondialdehyde ; Multiple Organ Failure ; Oxidants ; Rats* ; Sepsis ; Superoxide Dismutase ; Vitamins*

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of Tc-99m labeled antigranulocyte antibody immunoscintigrapy in the diagnosis of osteomyelitis and compare with the results of triphasic bone scan. MATERIALS AND METHODS: The study population was 39 patients (22 male, 17 female) who had uncertain diagnoses of osteomyelitis. Fifteen patients had history of orthopedic surgery, and 5 had previous fracture. One milligram of monoclonal antibody against NCA-95 was labeled with 370 MBq of Tc-99m, injected intravenously, and 4 hour images were obtained. Triphasic bone scan images were obtained in 30 p;tients. The final diagnosis was confirmed by bacteriologic culture, biopsy or long term clinical follow up. RESULTS: Twenty one patients were confirmed to have osteomyelitis (1 acute, 20 chronic). Eighteen patients were without osteomyelitis. Antigranulocyte antibody immunoscintigraphy had a sensitivity of 71% (15/21), and a specificity of 89% (16/18), while the sensitivity and specificity of triphasic bone scan was 93% (13/14) and 38% (6/16), respectively. Antigranulocyte antibody scan showed higher specificity of 100% (11/11) in comparison with 33% (3/9) of triphasic bone scan in patients with history of orthopedic surgery or fracture. CONCLUSION: Antigranulocyte antibody immunoscintigraphy is more specific than that of triphasic bone scan and may be helpful in patients with history of surgery or fracture. However, sensitivity is lower than triphasic bone scan in the detection of chronic osteomyelitis.
Biopsy ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Orthopedics ; Osteomyelitis ; Sensitivity and Specificity

Basal cell nevus syndrome is inherited as an autosomal dominant trait with variable expressivity. This syndrome comprises a number of abnormalities such as multiple nevoid basal cell carcinomas of the skin, skeletal abnormalities as bifid rib and fusion of vertebrae, central nervous system abnormalities as mental retardation, eye abnormalities, and multiple odontogenic kerato cysts. In 1960, Gorlin and Goltz first described the features of this disease as constituting a true syndrome; since then, it has been realized that it is much more complex and encompassing than initially thought. This patient has many symtoms of basal cell nevus syndrome. we has known multiple jaw cysts through panorama and facial computed tomography. He has hyperchromatism on basal cell through skin biopsy. In ophthalmologic consult, he has blindness on right. On his past medical history, amputation was done on his toes for polyductalism. - So we report with literature reviews
Amputation ; Basal Cell Nevus Syndrome* ; Biopsy ; Blindness ; Carcinoma, Basal Cell ; Central Nervous System ; Eye Abnormalities ; Humans ; Intellectual Disability ; Jaw Cysts ; Odontogenic Cysts ; Ribs ; Skin ; Spine ; Toes

PURPOSE: A retrospective study was performed to evaluate the efficiency and feasibility of twice daily radiation therapy plus concurrent chemotherapy for limited-stage small cell lung cancer in terms of treatment response, survival, patterns of failure, and acute toxicities. MATERIALS AND METHODS: Between February 1993 and October 2002, 76 patients of histologically proven limited-stage small cell lung cancer (LS-SCLC) were treated with twice daily radiation therapy and concurrent chemotherapy. Male was in 84% (64/76), and median age was 57 years (range, 32~75 years). Thoracic radiation therapy consisted of 120 or 150 cGy per fraction, twice a day at least 6 hours apart, 5 days a week. Median total dose was 50.4 Gy (range, 45~51 Gy). Concurrent chemotherapy consisted of CAV (cytoxan 1000 mg/m2, adriamycin 40 mg/m2, vincristine 1 mg/m2) alternating with PE (cisplatin 60 mg/m2, etoposide 100 mg/m2) or PE alone, every 3 weeks. The median cycle of chemotherapy was six (range, 1~9 cycle). Prophylactic cranial irradiation (PCI) was recommended to the patients who achieved a complete response (CR). PCI scheme was 25 Gy/ 10 fractions. Median follow up was 18 months (range, 1~136 months). RESULTS: Overall response rate was 86%; complete response in 39 (52%) and partial response in 26 (34%) patients. The median overall survival was 23 months. One, two, and three year overall survival rate was 72%, 50% and 30%, respectively. In univariate analysis, the treatment response was revealed as a significant favorable prognostic factor for survival (p<0.001). Grade 3 or worse acute toxicities were leukopenia in 46 (61%), anemia in 5 (6%), thrombocytopenia in 10 (13%), esophagitis in 5 (6%), and pulmonary toxicity in 2 (2%) patients. Of 73 evaluable patients, 40 (55%) patients subsequently had disease progression. The most frequent first site of distant metastasis was brain. CONCLUSION: Twice daily radiation therapy plus concurrent chemotherapy produced favorable response and survival for LS-SCLC patients with tolerable toxicities. To improve the treatment response, which proved as a significant prognostic factor for survival, there should be further investigations about fractionation scheme, chemotherapy regimens and compatible chemoradiotherapy schedule.
Anemia ; Appointments and Schedules ; Brain ; Chemoradiotherapy ; Cranial Irradiation ; Disease Progression ; Doxorubicin ; Drug Therapy* ; Esophagitis ; Etoposide ; Follow-Up Studies ; Humans ; Leukopenia ; Male ; Neoplasm Metastasis ; Retrospective Studies ; Small Cell Lung Carcinoma* ; Survival Rate ; Thrombocytopenia ; Vincristine