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

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

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

PURPOSE: To evaluate the treatment outcomes of the three-dimensional conformal radiotherapy (3D-CRT), in conjunction with induction chemotherapy, for the treatment of stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Between November 1998 and March 2003, 22 patients with histologically proven, clinical stage III NSCLC, treated with induction chemotherapy, followed by 3D-CRT, were retrospectively analyzed. There were 21 males (96%) and 1 female (4%), with a median age of 68.5 (range, 42~79). The clinical cancer stages were IIIA and IIIB in 41 and 59%, respectively. The histologies were squamous cell carcinoma, adenocarcinoma and others in 73, 18 and 9%, respectively. Twenty patients (91%) received induction chemotherapy before radiation therapy. The majority of the chemotherapy regimen consisted of cisplatin and gemcitabine. Radiation was delivered with conventional anteroposterior/ posteroanterior fields for 36 Gy, and then 3D-CRT was performed. The total radiation dose was 70.2 Gy. The median follow-up period was 17 months (range, 4~59 months). RESULTS: The median overall survival was 19 months. The two and four-year overall survival rates were 37.9 and 30.3%, respectively. The median progression-free survival was 21 months. The two and four-year progression-free survival rates were 42.1 and 21%, respectively. The prognostic factors for overall survival by a univariate analysis were age, histology and T stage (p<0.05). Acute radiation toxicities, as evaluated by the RTOG toxicity criteria, included two cases of grade 3 lung toxicity and one case of grade 2 esophagus toxicity. CONCLUSIONS: The radiation dose could be increased without a significant increment in the acute toxicities when using 3D-CRT. It also seems to be a safe, well- tolerated and effective treatment modality for stage III NSCLC.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Cisplatin ; Disease-Free Survival ; Drug Therapy ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Induction Chemotherapy ; Lung ; Male ; Radiotherapy, Conformal* ; Retrospective Studies ; Survival Rate

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*

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

OBJECTIVE: The purpose of this study is to report the technical feasibility and the result of one stage operation for the bursting fracture of the thoracolumbar spine by posterior approach. METHODS: Seven patients underwent corpectomy and replaced the space with titanium mesh cage filled up with autologous bone pieces through unilateral posterior route after removal of the facet joint and the pedicle followed by pedicle screw fixation at the same surgical field. RESULTS: All patients tolerated the procedures well except one patient complicated with air embolism. Postoperative radiographs showed effective decompression and well placed instruments. Preoperative neurological deficits disappeared completely in two patients but some deficits persisted in the remainders. In two patients, epidural venous bleeding was troublesome and he needed transfusion of 5 pints of packed red blood cell. And another patient complicated with air embolism during operation was recovered with impunity after operation. To insert the mesh cage through the narrow corridor posterolaterally, it was unavoidable to sacrifice one spinal root. CONCLUSION: In spite of technical difficulty, one stage spondylodesis for the bursting thoracolumbar spine though unilateral posterior approach seem to be an effective operative procedure.
Decompression ; Embolism, Air ; Erythrocytes ; Hemorrhage ; Humans ; Spinal Fractures ; Spinal Fusion* ; Spinal Nerve Roots ; Spine* ; Surgical Procedures, Operative ; Titanium ; Zygapophyseal Joint

No abstract available.
Joints*

PURPOSE: The objective of this study was to assess ventricular function by tissue Doppler imaging (TDI) in children with congenital heart disease (CHD) who have been undergoing open heart surgery (OHS) using cardiopulmonary bypass. We tried to compare the parameters of tissue Doppler imaging before and after OHS in patients with congenital heart disease. METHODS: This study was conducted on 32 patients with CHD after OHS from January 2005 to December 2005 at Kyungpook National University hospital. Patients who underwent 2-D echocardiography before and after their OHS. All patients were divided into three groups, left ventricular volume overloading group (group 1), and right ventricular volume overloading group (group 2), and right ventricular pressure overloading group (group 3). The TDIs were examined before and 1 to 3 months after OHS. Peak early diastolic (E), and peak late diastolic (A) velocity of transmitral flow were measured by pulsed wave Doppler examination. Peak systolic (Sm), peak early diastolic (Em), and peak late diastolic (Am) velocity in apical 4-chamber and 2-chamber views were measured by TDI. The author calculated E/Em ratio. RESULTS: The patients were 14 boys and 18 girls and the average age of patients was 2 years and 3 months. The congenital heart diseases which have to get OHS were ventricular septal defect (13 cases), atrial septal defect (7), atrioventricular septal defect (3), isolated pulmonary stenosis (2) and tetralogy of Fallot (7). There were significant decrease of Sm, Em, Am measured on tricuspid annulus and E/Em measured on mitral annulus in apical 4 chamber view (P<0.05). CONCLUSION: This study showed significant decrease of Sm, Em, Am measured on tricuspid annulus and E/Em measured on mitral annulus in apical 4 chamber view after OHS. These changes might be due to the effects of cardiopulmonary bypass in OHS and/or hemodynamic changes after correction of congenital heart disease. To clarify these changes, further study on more patients is needed.
Cardiopulmonary Bypass ; Child ; Echocardiography ; Echocardiography, Doppler ; Female ; Gyeongsangbuk-do ; Heart Defects, Congenital* ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Postoperative Period* ; Pulmonary Valve Stenosis ; Tetralogy of Fallot ; Thoracic Surgery ; Ventricular Function ; Ventricular Pressure