Reinforced endotracheal tubes (ETTs) are designed to resist kinking or compression. However, these have a potential risk of being obstructed or severed by a patient's bite. We report a case in which a reinforced ETT was severed by tube-bite while the patient was in the prone position during an intensive care unit stay. Bronchoscopic evaluation showed that the severed distal part of the tube had lodged in the patient's right main bronchus, and it had to be surgically removed. The patency of reinforced ETTs should be carefully monitored in patients intubated in the prone position.
Airway Obstruction ; Bronchi* ; Bronchoscopy ; Humans ; Intensive Care Units ; Intubation ; Patient Rights ; Prone Position

BACKGROUND: A medulloblastoma is a primitive neuroepithelial tumor of the cerebellum that occurs in children and metastasizes through the cerebrospinal fluid. It is highly malignant and invasive, and the 5-year survival rate is only 60%. Surgical resection techniques, radiation, and chemotherapy have improved the overall survival but the patients suffer life-long cognitive dysfunctions or endocrine abnormalities as the side effects of treatment. Therefore it is essential to identify prognostic markers to determine the appropriate treatment strategy in order to minimize the side effects. METHODS: This study evaluated the immunohistochemical differentiation and survival rate with synaptophysin, glial fibrillary acidic protein, epithelial membrane antigen, vimentin and primitive neuroepithelial marker nestin of 55 paraffin-embedded medulloblastomas, using a tissue microarray. The expression of survivin, the apoptotic inhibitor, and the survival rate with regard to the proliferation index of Ki-67 were also investigated. RESULTS: The group testing positive to vimentin, a mesenchymal differentiation marker, had a worse prognosis and there was a strong correlation between vimentin expression and nestin expression. Patients with a survivin expression rate >35% had a significantly poorer clinical course and there was a correlation between the survivin expression rate and Ki-67 expression rate. CONCLUSION: In conclusion, vimentin and survivin are negative prognostic markers in medulloblastomas.
Cerebellum ; Cerebrospinal Fluid ; Child ; Drug Therapy ; Glial Fibrillary Acidic Protein ; Humans ; Medulloblastoma* ; Mucin-1 ; Nestin ; Neuroectodermal Tumors, Primitive ; Prognosis ; Survival Rate ; Synaptophysin ; Vimentin*

One hundred and seventy-two cases of tuberculosis of the bones and joints were treated at the department of orthopedic surgery, Inchon Christian Hospital during the 3 years and 10 months from March, 1979, to December, 1982. The results obtained were as followings: 1. The incidence was decreased progressively 1.92% in 1980 to 1.18 in 1982. 2. Tuberculous lesions involved spine(50.58%), knee(16.28%), hip(13.37%), ankle(2.33%) and greater trochanter(2.33%) in order. 3. Age and sex distribution were not remarkable. 4. The main associated tuberculous lesions were pulmonary tuberculosis and tuberculous pleurisy (20.65%). Therefore, pulmonary problems should be always carefully investigated in every case of skeletal tuberculosis. 5. Average duration of disease was one year and 3.5 months, average hospital days was one month. 6. Initial miss diagnosis of lesions ultimately proved to be tuberculosis. Rheumatoid arthritis:13 cases, Osteoarthritis : 3 cases, Herniated lumbar disc: 3 cases, Cellulitis :2 cases, Neoplasm :2 cases. Early diagnosis is essential since proper therapy is available and far advanced destruction, long suffering and disability can be avoided. 7. Post operative complication was mainly due to failure of bone graft in tuberculous spondylitis and was draining sinus formation and wound disruption in other skeletal tuberculosis. 8. The result of treatment of skeletal tuberculosis from conservative methods were relatively poor. The corroboratory care of skeletal tuberculosis can be obtained by extensive surgery.
Cellulitis ; Diagnosis ; Early Diagnosis ; Incheon ; Incidence ; Joints ; Orthopedics ; Osteoarthritis ; Sex Distribution ; Spondylitis ; Transplants ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary ; Wounds and Injuries

We experienced a case of arteriovenous hemangioma showing Dariers sign on the forehead of a 43-year-old man. He presented with a single, 1 * 1.5cm sized, violaceous, asymptomatic nodule with a history of an intermittent wheal at the lesional site. This skin lesion showed Dariers sign clinically and proliferation of mast cells histopathologically with the punch biopsy specirnen suggesting urticaria pig- mentosa. Howerer, we could diagnose it as a arteriovenous hemangioma on complete excision, as the specimen showed arteriovenous proliferation with increased mast cells in a perivascular pattern. This case showed confusing clinical signs and showed the importance of complete excision for the diagnosis of a small skin tumor especially when a vascular proliferating tumor is suspected.
Adult ; Biopsy ; Diagnosis ; Forehead ; Hemangioma* ; Humans ; Mast Cells ; Skin ; Urticaria

No abstract available.
Sperm-Ovum Interactions* ; Spermatozoa*

PURPOSE: To evaluate the surgical results and the amount of correction per millimeter after unilateral lateral rectus recession for moderate-angle exotropia in a pediatric population. METHODS: This study included 30 subjects who underwent 9-mm unilateral lateral rectus recession for basic type intermittent exotropia with deviation of 23 to 28 prism diopters (PD) and were followed-up for 6 months or more after surgery. RESULTS: Seventeen subjects were male and 13 were female. The mean age of subjects was 9.7 years. Defining satisfactory postoperative ocular alignment as 8PD or less, 25 of 30 subjects (83.3%) were satisfactorily aligned at 2 months postoperatively. The success rates at 4, and 6 months postoperatively were 76.7% respectively. No overcorrected subjects were found after 2 months postoperatively. A postoperative limitation of abduction was not found in all subjects after 2 months postoperatively. The average amount of correction per millimeter of recession at 2, 4, and 6 months was 2.83+/-0.26PD, 2.75+/-0.37PD, and 2.72+/-0.44PD respectively (range, 1.56 to 3.18PD). There was no statistically significant difference in the amount of correction per millimeter throughout the follow-up period (ANOVA, p=0.05). CONCLUSIONS: Unilateral lateral rectus recession appears to be an effective surgical procedure for the treatment of moderate-angle exotropia. However to reduce the rate of undercorrection, which is one of disadvantages of this procedure, proper patient selection is required.
Exotropia* ; Female ; Follow-Up Studies ; Humans ; Male ; Patient Selection

No abstract available.
Animals ; Brain* ; Ischemia* ; Prosencephalon* ; Rats*

BACKGROUND AND PURPOSE: The "closing-in" phenomenon refers to the tendency to copy near or overlap a model while performing figure-copying tasks. The mechanisms underlying the closing-in phenomenon have not been fully elucidated, and previous studies only investigated the mechanisms through neuropsychological tests. We investigated the neuroanatomical correlates of the closing-in phenomenon using voxel-based morphometry (VBM). METHODS: Thirty-eight patients diagnosed with probable Alzheimer's disease (AD) and 21 normal controls were included. All subjects underwent neuropsychological testing to diagnose dementia and magnetization prepared rapid acquisition gradient echo brain magnetic resonance imaging for the voxel-based statistical analysis. The subjects were asked to copy the modified Luria's alternating squares and triangles to quantify the closing-in phenomenon. We applied SPM8 for the VBM analysis to detect gray matter loss associated with the closing-in phenomenon. RESULTS: The patients with probable AD showed a higher closing-in score than that of the normal control subjects (p<0.0001). The VBM analysis revealed more parietal and temporal atrophy in the patients with AD than that in the normal control group. Moreover, atrophy of the orbito-frontal area was associated with the closing-in phenomenon. CONCLUSIONS: The closing-in phenomenon is dysfunction while performing figure-copying tasks and is more common in patients with AD. The analysis of the orbito-frontal area, which is associated with inhibiting primitive reflexes, revealed that the closing-in phenomenon is an imitation behavior commonly observed in patients with frontal lobe damage.
Alzheimer Disease ; Atrophy ; Brain ; Dementia ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Neuropsychological Tests ; Rabeprazole ; Reflex

BACKGROUND AND OBJECTIVES: Slow flow or no-reflow during the primary angioplasty is associated with a poor prognosis. The impact of adjuvant balloon inflation on infarct artery flow after successful primary stenting has not yet been studied. Therefore, we investigated the effect of adjuvant balloon inflation on infarct related artery flow after successful stenting in patients with acute myocardial infarction. SUBJECTS AND METHODS: The changes in infarct artery flow before and after adjuvant balloon inflation were assessed in 46 patients with a first episode of acute myocardial infarction (pain duration > 12 hr) who underwent adjuvant balloon inflation after successful primary stenting. Infarct artery flow was evaluated by corrected TIMI frame count (CTFC). RESULTS: After adjuvant balloon inflation, 20 patients (43%) showed a slower flow. The minimal lumen diameter became greater (3.0 > 0.5 mm vs. 3.2 > 0.5 mm, p=0.002) and the residual stenosis lessened (12.2 > 9.6% vs. 6.4 > 8.1%, p<0.001). There was no change in reference vessel diameter. CTFC was significantly increased after adjuvant balloon inflation (21.6 > 11.5 frames vs. 26.9 > 20.5 frames, p=0.005). On multivariate analysis, only pre-adjuvant balloon CTFC was a predictor of a slower flow after adjuvant balloon inflation (odds ratio 1.148, 95% CI:1.014-1.301). CONCLUSION: Adjuvant balloon inflation after successful primary stenting reduced residual stenosis but deteriorated the infarct artery flow. Further studies are required to define the clinical impact of the positive and negative effects of adjuvant balloon inflation.
Angioplasty ; Arteries* ; Constriction, Pathologic ; Coronary Circulation ; Humans ; Inflation, Economic* ; Multivariate Analysis ; Myocardial Infarction ; Prognosis ; Stents*

BACKGROUND AND OBJECTIVES: We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD). SUBJECTS AND METHODS: A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed. RESULTS: Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001). CONCLUSION: Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.
Cohort Studies ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Death ; Follow-Up Studies ; Homocysteine* ; Humans ; Male ; Myocardial Infarction ; Prognosis ; Propensity Score* ; Risk Factors