CHAP syndorme consists of choreoathetosis, orofacial dyskinesia, affective change, hypotonia, and pseudobulbar signs. CHAP syndrome was firstly des- cribed with onset 1 to 7 days after induced profound hypothermia and complete circulatory arrest for con- genital heart lesion repair. Since then, only a few cases have been reported until now. Case We report a patient who demonstrated all of the elements of the CHAP syndrome in severe cachexic state. Brain SPECT(99mTC-ECD) shows decreased perfusion in left fronto-parieto-temporal lobe. Comments The pathogenesis of CHAP syndrome is obscure. However our case led us to suggest that more essential component pre- disposing to the CHAP syndrome is hypoxia rather than hypothermia. Furthermore, it seems to be related with circulatory insufficiency in extrapyramidal nervous systems.
Anoxia ; Brain ; Heart ; Humans ; Hypothermia ; Movement Disorders ; Muscle Hypotonia ; Nervous System ; Perfusion

PURPOSE: In this retrospective study, we attempted to evaluate the treatment outcome and the prognostic factors of thymoma treated with surgery, radiotherapy and chemotherapy. METHODS AND MATERIALS: Between 1979 and 1998, 55 patients with thymoma were treated at the Seoul National University Hospital. Of these, 11 patients underwent surgery only, 33 patients received postoperative radiotherapy and 11 patients received radiotherapy only. Twenty-three patients had gross total resection and 21 patients subtotal resection. For postoperative radiotherapy, the radiation dose consisted of 41.4-55.8 Gy. The average follow-up was 64 months, and ranged from 2 to 160 months. The sex ratio was 1:1 and the median age was 48 years (15-74 years). Overall survival and disease-free survival were determined via the Kaplan-Meier method, and the log-rank was employed to evaluate for differences in prognostic factor. RESULTS: The five- and 10-year survival rates were 87% and 65% respectively, and the median survival was 103 months. By univariate analysis, only stage ( p=0.0017) turned out to be significant prognostic factors of overall survival. Also, stage ( p=0.0007) was significantly predictive for overall survival in mutivariated analysis. CONCLUSION: This study showed the stage was found to be important prognostic factors, which influenced survival. Especially, as incomplete resection is related with poor results, complete resection is important to cure the invasive thymoma.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiotherapy ; Retrospective Studies ; Seoul ; Sex Ratio ; Survival Rate ; Thymoma* ; Treatment Outcome*

BACKGROUND: With the advance of socioeconomy and medical science, the population of the aged has been significantly increased. Therefore it needs to be studied the fundamental epidemiologic survey of dermatologic disease in the elderly. OBJECTIVES: The purpose of this study is to evaluate the prevalence of common dermatoses in the elderly and to compare these to previous studies. METHOD: 1,916 out-patients over 65 years old who had visited the Department of Dermatology, University Hospital and Yongsan Hospital, College of Medicine, Chung Ang University from January, 1996 to December, 2001 were analyzed retrospectively. RESULTS: 1. The incidence of aged group over 65 years old to total number of out-patients(24,723) was 7.7%(1,916 cases). 2. The ratio of male to female was 1.06 : 1(986:930). 3. The frequent skin diseases were herpes zoster(12.0%), benign tumor(9.0%), pruritus(8.9%), onychomycosis/tinea pedis(7.7%), contact dermatitis(7.2%), seborrheic dermatitis(5.4%). 4. Eczema was the most common disease group which revealed 18.5%. The second most frequent group was viral infection(15.3%), followed by fungal infection(12.7%), tumor(12.0%), urticaria, drug eruption and erythema(9.4%), pruritus(8.9%), papulosquamous disease(2.8%) and bacterial infection(2.6%). 5. The most common disease in each disease group were as follows : contact dermatitis in eczema, herpes zoster in viral infection, onychomycosis and tinea pedis in fungal infection, urticaria in urticaria, drug eruption and erythema group, generalized pruritus in pruritus group, psoriasis in papulosquamous disease and folliculitis in bacterial infection, respectively. 6. Among 235 cases of skin tumor, 175 cases(74.5%) were benign and the remaining 60 cases(25.5%) were premalignant or malignant. The frequency of benign tumor was in order of seborrheic keratosis, epidermal cyst, skin tag and lipoma, respectively. In malignancy, there were basal cell carcinoma, squamous cell carcinoma and cutaneous metastatic carcinoma. CONCLUSION: Compared to previous studies, tumor and pruritus showed a increasing tendency but eczema a decreasing tendency.
Aged* ; Bacterial Infections ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatitis ; Dermatitis, Contact ; Dermatology ; Drug Eruptions ; Eczema ; Epidermal Cyst ; Erythema ; Female ; Folliculitis ; Herpes Zoster ; Humans ; Incidence ; Keratosis, Seborrheic ; Lipoma ; Male ; Onychomycosis ; Outpatients ; Prevalence ; Pruritus ; Psoriasis ; Retrospective Studies ; Skin Diseases* ; Skin* ; Tinea Pedis ; Urticaria

BACKGROUND: Anesthetic techniques for laryngeal microsurgery aims on modulation of sympathetic stimulation, good relaxation and rapid recovery from deep anesthesia. This study was designed to compare the influence of the different anesthetic methods on the cardiovascular responses and the recovery patterns during suspension laryngoscopic surgery. METHOD: Sixty patients of ASA class 1 or 2 scheduled for suspension laryngoscopic surgery were divided into 4 groups randomly. Two groups were anesthetized with inhalational anesthetic, enflurane, and other two groups were anesthetized with intravenous anesthetic, propofol. In each groups, esmolol or fentanyl was used as an adjunctive during anesthesia. When blood pressures increased above 30% of baseline value each adjunctive was added. The changes of blood pressure and heart rate were compared with each others during operation. Postoperatively, the start of spontaneous respiration, consciousness, memory, and the frequencies of other complications were also compared with each others. RESULT: The results were as follows; 1) The blood pressures and heart rates during operations were not different among the groups. 2) The recovery of spontaneous respiration was early in propofol esmolol group. 3) 30 minutes after operation, the consciousness state was better and complications were less in propofol groups compared with enflurane groups. CONCLUSION: From this results, it seems that propofol with nitrous oxide and supplemental fentanyl or esmolol may be useful in laryngeal microsurgery. Especially, esmolol can be a good substitute for those who can't be treated with opioids.
Analgesics, Opioid ; Anesthesia ; Blood Pressure ; Consciousness ; Enflurane ; Fentanyl ; Heart Rate ; Humans ; Laryngoscopy ; Memory ; Microsurgery ; Nitrous Oxide ; Propofol ; Relaxation ; Respiration

PURPOSE: To describe the clinical outcome of AMT (amniotic membrane transplantation) for corneal ulcers, persistent epithelial defects, corneal perforations, and neurotropic ulcers. METHODS: We performed AMT on 10 cases of corneal ulcer, 5 cases of persistent epithelial defect, 2 cases of corneal perforation, and 3 cases of neurotropic ulcer from Agust 1999 to May 2002. Amniotic membrane was obtained from the women undergoing elective Cesarean section or normal delivery. We had applied one or two layers of fresh amniotic membrane, that is used within 4hours after resection, over the ulcer bed and anchored by interrupted and running suture technique with 10-0 Nylon. After AMT, Topical eye drops was used three times a day. RESULTS: After AMT, Visual acuity was improved in 6 eyes of 10 corneal ulcer patients and maintained in 3 eyes. In all patients the persistent epithelial erosion was healed and pain was subsided between 6 and 12 days after surgery. There were no leakage in corneal perforation patients, and stable ocular surface were achieved after mean period 15.5 days. The ocular surface was restored by AMT in all neurotropic ulcer patients. CONCLUSIONS: The AMT is an effective method for managing corneal ulcer or ocular surface diseases, that are refractory to conventional treatment. The AMT shortened the usage of broad spectrum antibiotics , increased compliance, and decreased corneal opacity and neovascularization.
Amnion* ; Anti-Bacterial Agents ; Cesarean Section ; Compliance ; Corneal Opacity ; Corneal Perforation ; Corneal Ulcer* ; Female ; Humans ; Membranes ; Nylons ; Ophthalmic Solutions ; Pregnancy ; Running ; Suture Techniques ; Ulcer ; Visual Acuity

Cyclosporine A(CsA) induced nephrotoxicity is a common clinical problem in the patients who underwent organ transplantation and subsequent immunosuppressive therapy. The precise pathophysiology of CsA induced nephrotoxicity still remains uncertain though many hypothesized mechanisms were reported. Therefore, no effective strategy is currently available to counter the nephrotoxic effects of CsA while cyclosporine G or cyclosporine microemulsion was tried to reduce the toxic effects. Recently, CsA was reported to induce lipid peroxidation in renal cortical mitochondria, which may cause mitochondrial damage. To examine the hypothesis of lipid peroxidation in the pathogenesis of acute CsA induced nephrotoxicity, antioxidant vitamin E was co-administerated in the CsA induced acute nephrotoxicity. Sprague Dawley male rats weighing from 250 to 400 gm were heminephrectomized 7 days prior to the experiments. The rats were divided into 3 groups and each group consisted of 7 rats. In group I(control group), the rats were given sterilized olive oil intraperitoneally, in group II(CsA group), CsA 50 mg/kg of body weight/day intraperitoneally, and in group III(CsA with vitamin E), CsA 50 mg/kg of body weight/day intraperitoneally with vitamin E 10 mg/kg of body weight/day intramuscularly for 7 days respectively. From the 6th day, all experimental animals were placed in a metabolic cage collecting urine for the measurement of 24-hours urine thromboxane B2, the metabolite of thromboxane A2. On the 7th day, at the sacrifice of the experimental animals, blood samplings for the measurement of blood CsA level and serum creatinine and left nephrectomy for morphological study were performed. Comparison of mean serum creatinine levels between 2 study groups revealed 171.7+/-164.2 micro Mol/L in group II and 53.4+/-13.9 micro Mol/L in group III(p<0.05). Mean 24-hour urine thromboxane B2 levels were 39.0+/-6.9 ng/24 hours in group I, 74.8+/-22.6 ng/24 hours in group II, and 34.5+/-8.0 ng/24 hours in group III. Urine thromboxane B2 was significantly(p=.0026) lower in group III. The differences of morphological changes in group II and III can be summarized as a diminution of PAS(+) granules under the light microscope and a diminution of the numbers of secondary lysosomes in the proximal tubular epithelial cell under the electron microscope. In conclusion, this animal study provides an evidence that CsA-induced acute nephrotoxicity is related with lipid peroxidation and the antioxidant, vitamin E was considered to ameliorate CsA-induced acute nephrotoxicity in rats.
Animals ; Creatinine ; Cyclosporine* ; Epithelial Cells ; Humans ; Lipid Peroxidation ; Lysosomes ; Male ; Mitochondria ; Nephrectomy ; Olea ; Olive Oil ; Organ Transplantation ; Rats* ; Thromboxane A2 ; Thromboxane B2 ; Transplants ; Vitamin E* ; Vitamins*

BACKGROUND: It was recently shown that human atherosclerotic plaque contains large numbers of T lymphocytes : this indicates that immune and inflammatory mechanism may be important factors in the pathogenesis of atherosclerosis. By measuring the soluble interleukin 2 receptor(sIL-2R) level we can evaluate the activation of T lymphocyte. The purpose of this study is to evaluate relationship between T cell activation and ischemic heart disease by measuring the soluble interleukin 2 receptor (sIL-2R) level in patient with ischemic heart disease. METHOD: Seventy-two patients(40 males and 32 female, mean age : 56.5+/-9.9 years) who were taken coronary angiography were included in this study. Among them, 49 patients showed abnormal coronary angiographic findings and 23 patients showed normal coronary angiographic findings. Ten mililiters of arterial blood was drawn at the time of coronary angiography. The blood was allowed to coagulate and then the serum was removed and tested in duplicate for soluble interleukin 2 receptor (sIL-2R) level by ELISA. RESULTS: 1) The soluble interleukin 2 receptor (sIL-2R) level was significantly different between abnormal coronary angiographic findings and normal coronary angiographic findings (P < 0.001). 2) According to clinical severity of ischemic heart disease (i.e. stable angina, unstable angina, acute myocardial infarction.), soluble interleukin 2 receptor (sIL-2R) level was not significantly different between single vessel disease group and multivessels disease groups (p > 0.05), but showed increasing tendency with clinical severity. 3) According to numbers of involved coronary vessels, soluble interleukin 2 receptor (sIL-2R) level was not significantly different between single vessel disease group and multivessels disease groups (p > 0.05). CONCLUSION: T lymphocyte activation, as reflected in elevated soluble interlekin 2 receptor (sIL-2R) level, is frequent in patient with ischemic heart disease. In the further we will investigate relationship between clinical diagnosis of ischemic heart disease of the numbers of involved coronary vessels and T cell activation.
Angina, Stable ; Angina, Unstable ; Atherosclerosis ; Coronary Angiography ; Coronary Vessels ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Interleukin-2 ; Lymphocyte Activation ; Lymphocytes ; Male ; Myocardial Ischemia* ; Plaque, Atherosclerotic ; Receptors, Interleukin-2 ; T-Lymphocytes

PURPOSE: Although adjuvant chemotherapy reduces the risk of disease recurrence in stage III colon cancer patients, published guidelines do not specify when it should be initiated. This study aimed to assess the effect of adjuvant chemotherapy initiation time on disease recurrence and survival in stage III colon cancer patients undergoing curative surgical resection. METHODS: The medical records of stage III colon cancer patients undergoing curative resection between February 2004 and December 2009 were reviewed. RESULTS: Of the 133 enrolled patients, 27 (20.3%) began adjuvant chemotherapy within 3 weeks of surgery, whereas 106 (79.7%) did after 3 weeks following surgery. Patients receiving chemotherapy within 3 weeks of surgery were less likely to experience recurrences than those beginning treatment later (11.1% vs. 33%, P = 0.018). The mean disease-free survival of patients receiving adjuvant therapy earlier was 54.6 months, whereas that of patients with later treatment was 43.5 months (P = 0.014). However, no significant differences in overall survival were observed between the 2 groups. CONCLUSION: Adjuvant chemotherapy should be initiated as soon as a patient's clinical condition allows. Patients with stage III colon cancer may benefit from adjuvant chemotherapy initiated within 3 weeks of surgery.
Chemotherapy, Adjuvant* ; Colon* ; Colonic Neoplasms* ; Disease-Free Survival ; Drug Therapy ; Humans ; Medical Records ; Prognosis ; Recurrence

Kimura's disease is an uncommon, chronic inflammatory disorder of unknown etiology that is seen in an endemic form in the Orient. It usually presents as a mass in the subcutaneous tissue of the head and neck region or the major salivary glands, and is often associated with a regional lymphadenopathy. The patients have peripheral blood eosinophilia and elevated IgE levels but are otherwise usually healthy. We encountered the case of a 33-year-old man who had a soft tissue mass in his left distal arm which was diagnosed as being Kimura's disease.
Adult ; Arm* ; Eosinophilia ; Head ; Humans ; Immunoglobulin E ; Lymphatic Diseases ; Neck ; Salivary Glands ; Subcutaneous Tissue

Transcatheter arterial chemoembolization (TACE) improves the survival rate in patients with hepatocellular carcinoma (HCC). Despite the low probability, iatrogenic hepatic arterial dissections during interventional procedure are rarely created by the technical difficulties. Direct trauma from the guidewire, the tip of the catheter, or the jet of contrast injection can contribute to iatrogenic hepatic arterial dissections. We report one case of a female who had HCC necrosis caused by iatrogenic hepatic arterial dissection during TACE. Ischemia resulting from iatrogenic hepatic arterial dissection during TACE was smilar to the result of transarterial embolization for HCC on our case. To our knowledge, none of the similar cases was reported in previously published literatures.