No abstract available.
Cerebrospinal Fluid Rhinorrhea ; Meningitis, Bacterial ; Rhinoplasty

There are some kinds of neoplasms to be differentiated in the clival area, such as chordoma, invasive pituitary adenoma, craniopharyngioma, trigeminal neuroma, epidermoid cyst, and epidermoid tumor. A 12-year-old girl had admitted with a chief complaint of diplopia. On computed tomography and magnetic resonance(MR) image , cystic mass of about 4cm in diameter which partially destroyed bony structure at posterior part of the clivus was compressing brainstem slightly at anterior direction. This mass showed hyperintensity on T2-weighted MR image, hypointensity on T1-weighted MR image and especially hyperintensity on diffusion image, but no contrast enhancement. So, We suspected a epidermoid cyst and planned biopsy through a transsphenoidal approach. Fortunately, tumor was removed completely. This tumor was considered as epidermoid cyst on MR image. But, it was confirmed as chordoma in pathologic diagnosis. Therefore, we report this case and it may be helpful to make a differential diagnosis in clival cystic chordoma preoperatively that has multilobulation, bony erosion, and calcification on radiologic findings.
Biopsy ; Brain Stem ; Child* ; Chordoma* ; Cranial Fossa, Posterior ; Craniopharyngioma ; Diagnosis ; Diagnosis, Differential ; Diffusion ; Diplopia ; Epidermal Cyst ; Female ; Humans ; Magnetic Resonance Imaging* ; Neuroma ; Pituitary Neoplasms

BACKGROUND AND OBJECTIVES: The repolarization abnormalities, after radiofrequency catheter ablation (RFCA) of accessory pathway (AP) in patients with Wolff-Parkinson-White (WPW) syndrome, is commonly appeared in standard 12 lead electrocardiogram (ECG) as inverted T waves. We analyzed the serial ECGs after RFCA of AP in patients with WPW syndrome, in order to understand the repolarization abnormalities after RFCA. MATERIALS AND METHOD: The study patients were consisted of ninety two patients (mean age: 35 years old, male: 56 patients) out of 157 patients whose ECGs were taken at before, immediately after, one day, one, four, eight, twelve week (s) after RFCA from December 1992 to July 1997. RESULTS: The seventy three patients (79%) out of ninety two patients showed the repolarization abnormalities and the thirteen patients (14%) showed normalization of secondary T wave changes immediately after RFCA. In contrast, six patients (7%) did not show any T wave changes after RFCA and they had left lateral AP. The lead that most frequently showed inverted T wave changes after RFCA was lateral lead (lead I, aVL) in case of left lateral AP and inferior lead (II, III, aVF) in case of other APs. The incidence of repolarization abnormalities after RFCA was significantly higher in patients whose preRFCA QRS duration is longer (> or =0.12 sec). The concordance rate of repolarization abnormalities after RFCA was 86% (63 patients of 73 patients showing repolarization abnormalities after RFCA). The normalization of repolarization abnormalities after RFCA was acquired in sixty four patients (94%) out of sixty eight patients who showed repolarization abnormalities and followed up to twelve weeks after RFCA. The mean time interval to the normalization of repolarization abnormalities after RFCA was 4.3+/-3.2 weeks. The time interval to the normalization of repolarization abnormality after RFCA was not related with age, AP or preRFCA QRS duration. CONCLUSION: The ECG lead, in which the repolarization abnormalities occurs after RFCA , is related with the location of the AP. The repolarization abnormalities after RFCA were more common in patients with longer preRFCA QRS duration. The repolarization abnormalities after RFCA could not be understood only by cardiac memory.
Adult ; Catheter Ablation* ; Electrocardiography ; Humans ; Incidence ; Male ; Memory ; Wolff-Parkinson-White Syndrome

BACKGROUND: Free-flap surgery and skin grafting can be used to reconstruct large facial defects that may result after skin cancer removal by Mohs micrographic surgery (MMS). However, these two methods may produce low postsurgical patient satisfaction with aesthetics, and free-flap surgery may produce an undue burden for the majority of skin cancer patients, who are of advanced age. Hence, the authors examined outcomes of large facial defect reconstruction using multiple flaps. METHODS: Among patients undergoing MMS for skin cancer at Pusan National University Hospital between January 2013 and December 2015, we evaluated 7 patients (2 males, 5 females; average age, 73.14 years) treated for large facial defects from basal cell carcinoma. Based on operative and follow-up records, we investigated the number and type of flaps used, postsurgical complications, and patients' post-surgical satisfaction. RESULTS: Two and 3 types of flaps were used for 5 and 2 patients, respectively. Most frequently used were nasolabial flaps (7 times in 6 patients) and forehead flaps (once in each of 4 patients). The average follow-up period was 14 months, with no complications—including necrosis, hematoma, or wound dehiscence—observed. Post-surgical satisfaction averaged 4.4 out of a maximum of 5 points. CONCLUSIONS: Reconstruction using two or more flaps for large facial defects after skin cancer removal using MMS produced satisfactory outcomes while preventing aesthetic problems. Practitioners should consider using multiple flaps when choosing a reconstruction method for large facial defects following skin cancer removal.
Busan ; Carcinoma, Basal Cell ; Esthetics ; Female ; Follow-Up Studies ; Forehead ; Hematoma ; Humans ; Male ; Methods ; Mohs Surgery ; Necrosis ; Patient Satisfaction ; Skin Neoplasms* ; Skin Transplantation ; Skin* ; Wounds and Injuries

Systolic time interval measurements were made sequentially during second, third trimesters and postpartum period. Recordings were made in the supine position after bed rest for at least five minutes in order to obtain a steady state. In second trimester, pre-ejection period index (PEPI) was significantly shortened and left ventricular ejection period index(LVETI) remained normal while PEP/LVET decreased. Four possible mechanisms may be involved to account for the alterations in hemodynamic changes during this period(late stage of second trimester) : (1) increased metabolic demands of pregnancy: (2) hemodynamic effects of hypervolemia: (3) circulatory adjustments secondary to an arteriovenous shunt-like effect of the placental circulation: (4) cardiovascular effect of steroid hormone. The third trimester was characterized-by a markedly shortened LVETI, a prolonged PEPI and PEP/LVET. This findings are consistent with impaired left ventricular performance and are probably due to decreased left ventricular preload resulting from diminished venous return secondary to inferior vena caval obstruction by the large gravid uterus. In the postpartum period, the PEPI and PEP/LVET remained elevated and the LVETI shortened in the supine position. It is concluded that alterations in systolic time intervals occur normally during the course of uncomplicated pregnancy and persist into the postpartum period.
Bed Rest ; Female ; Hemodynamics ; Humans ; Placental Circulation ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third* ; Supine Position ; Systole* ; Uterus

INTRODUCTION: There has been an increasing interest in the relationship between sleep and suicidality. In addition, suicidal patients habitually report their sleep problems. Although sleep-related complaints and electroencephalographic changes are generally encountered in psychiatric disorders, sleep complaints such as insomnia, hypersomnia and nightmares are more common in suicidal patients. In current study, we aimed at investigating the relationship between self-reported sleep duration and suicidality in general population. METHODS: One thousand general population (male : female=500 : 500, mean age=39.6+/-11.6 years, ranged age=20-77 years) completed Center for Epidemiologic Study-Depression (CES-D), Beck Suicide Intent scale (BSI), Spielberger State-Trait Anger Expression Inventory (STAXI), Barratt Impulsiveness Scale (BIS), Morningness-Eveningness Scale (MES) and brief questionnaire of sleep habits. RESULTS: After controlling for age and sex, score of BSI was correlated positively with the score of CES-D, STAXI and BIS on partial correlation analysis (r(p)=0.251 ; p<0.001, r(p)=0.352 ; p<0.001, and r(p)=0.175 ; p<0.001, respectively). In addition, score of BSI was inversely correlated with the score of MES (r(p)=-0.066; p=0.037). However, score of BSI showed no significant correlation with sleep duration. However, regression analysis revealed that short (<6 hrs) or long (>10 hrs) sleep duration, the family history of psychiatric illness, the score of CES-D, and the score of STAXI predicted higher score of BSI significantly in total subjects (F=17.837, adjusted R2 =0.166 ; p=0.003, p=0.003, p<0.001, and p=0.003, respectively). This model was explained better in depressed subjects with 16 or higher score of CES-D (F=9.920, adjusted R2=0.298). CONCLUSION: Current result suggested that not only short sleep duration (<6 hrs) but also long sleep duration (>10 hrs) might be related to suicidality.
Anger ; Depression ; Disorders of Excessive Somnolence ; Dreams ; Humans ; Surveys and Questionnaires ; Republic of Korea ; Sleep Initiation and Maintenance Disorders ; Suicide

OBJECTIVES: Working at other times than the regular day shift has been reported to be a stressor associated with health consequences and mental disorders as well as disturbance of sleep. In current study, we aimed at investigating the relationship between work schedule, sleep quality and depression among police officers. METHODS: Eleven hundreds and forty five police officers (male:1040, female:105) completed questionnaires of basic socio-demographic data, Pittsburgh Sleep Quality Index (PSQI), Korean Scale of Occupational Stress (KOSS), Impact of Event Scale - Revised (IES-R) and Center for Epidemiologic Study-Depression (CES-D). RESULTS: After controlling for age, sex and educational level, score of CES-D was correlated positively with the score of KOSS, PSQI and IES-R on partial correlation analysis (r=-0.077;p=0.009, r=0.262;p<0.000 and r=0.421, p<0.000, respectively). Logistic regression analysis revealed that female sex, age, the score of KOSS and IES-R and schedule of rotating shift work predicted higher score than 16 score of CES-D significantly in total subjects (p=0.023, p=0.015, p=0.000, p=0.000 and p=0.022, respectively). CONCLUSION: Current result suggested that not only female sex, age, higher occupational stress and impact of event scale but also rotating shift work schedule might be related to depression among police officers.
Appointments and Schedules ; Depression ; Female ; Humans ; Logistic Models ; Mental Disorders ; Police ; Surveys and Questionnaires ; Risk Factors

PURPOSE: Conventional indomethacin therapy(0.2mg/kg every 12 hours for three doses) has been used for closure of PDA. The effect of prolonged low dose of indomethacin therapy(0.1mg/kg daily for six days)had been reported in foreign country but, nothing had been reported in our country. So we attempted this study to examine effects of these two methods. METHODS: Forty one infants with PDA of prematurity from January 1992 to July 1995 who were admitted in NICU of Il Sin Christian Hospital were included. 27 of these infants received conventional dose of indomethacin therapy and 14 received prolonged low dose of indomethacin therapy, and we examined with closure rate and complication etc. RESULTS: 1) Closure of PDA was observed in 15(55.6%) and relapse was 3(11.1%) in conventional dose therapy group. In prolonged low dose therapy group, closure was 8(57.1%) and relapse was none. 2) Intraventricular hemorrhage was observed in 20(74.1%), 6(42.9%) and gastrointestinal tract bleeding was 6(22.2%), 13(92.2%) in each group. There was statistically significant between the two groups(p<0.05). 3) The rise of serum BUN, creatinine was observed in 9(33.3%), 6(46.2%), bleeding tendency was 9(33.3%), 8(57.1%), necrotizing enterocolitis was 2(7.4%), 0 and retinopathy of prematurity was 8(29.6%), 3(21.4%) in each group.But there was not statistically significant correlation between the two groups. 4) The development of sepsis and broncopulmonary dysplasia was slightly more in prolonged low dose therapy group. 5) The reduction of urine output was observed in 11(40.7%), 2(14.3%) in each group but, absolute oliguria was not observed in both groups. CONCLUSIONS: Though the closure rate of PDA was similar in both groups, prolonged low dose indomethacin therapy can be recommanded with its effectiveness on preventing the relapse of PDA and the accurrence of necrotizing enterocolitis.
Creatinine ; Enterocolitis, Necrotizing ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Indomethacin* ; Infant ; Oliguria ; Recurrence ; Retinopathy of Prematurity ; Sepsis

No abstract available.
Brain Stem* ; Classification* ; Hemorrhage*

PURPOSE: The main issue with the current ultrasonography (US) guidelines is the overestimation of malignant and indeterminate nodules as they do not aid in making decisions to treat patients. To overcome this, new US guidelines for thyroid nodules that have been shown to be better correlated with cytologic results have been proposed. We also suggested specific indications for US-guided fine needle aspiration (FNA) using the new US guidelines. METHODS: Clinical and pathologic data from 925 patients and 1,419 thyroid nodules were retrospectively collected. All subjects underwent US- and US-guided FNA at Department of Surgery, Wonju Christian Hospital, between March 2010 and July 2011. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both the current guidelines and the new guidelines. RESULTS: The accuracy, sensitivity, specificity, PPV, and NPV for the current guidelines in predicting malignancy were 24.1%, 99.3%, 62.2%, 25.0%, and 99.8%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV for the new guidelines in predicting malignancy were 66.0%, 96.0%, 86.7%, 47.7%, and 99.4%, respectively. CONCLUSION: The use of the new US guidelines allow for a more accurate and specific diagnosis and a better treatment plan than the current guidelines. Additionally, the use of the new FNA guidelines may help prevent unnecessary FNAs and promote cost-effective follow-up for patients.
Biopsy, Fine-Needle ; Follow-Up Studies ; Humans ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule