No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Epilepsy* ; Humans ; Seizures*

No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Violence*

No abstract available.
Encephalitis, Arbovirus*

Nosocomial pneumonia, which can develop in patients with prolonged intubation, may have in fatal consequences. The histamine type 2 blockers used for prevention of stress ulcers, increases gastric pH, and may increase the incidence of nosocomial pneumonia in patients with prolonged intubation by promoting bacterial overgrowth in the stomach and retrograde colonization in the trachea. We assessed the effect of histamine type 2 blockers on the incidence of nosocomial pneumonia in patients with prolonged intubation, who were admitted to the Intensive Care Unit, Young Dong Severance Hospital, Yonsei University College of Medicine from September 1992 to February 1993. The patients were divided into two groups Group 1 was the patients given histamine type 2 blockers and total parenteral nutrition, and Group 2 was the patients not given histamine type 2 blockers and with enteral feeding through the gastric tube. Gastric juice was aspirated for measurement of gastric pH. A culture of isolates was grown from endotracheal secretion and pharyngeal swab for identification of isolate cultured. Chest X-rays were taken for assess of pneumonic infiltrate, The results were as follows ;. 1. There were no difference of age, APACHE II scores at admission to ICU, duration of ICU stay and mortality between the two groups. 2. Gastric pH differed significantly between the two groups. In group 2, there was a significant difference between gastric pH before and after feeding. 3. The incidence of upper gastrointestinal bleeding did not differ between the two groups. 4. Colonization developed more frequently in the patients with enteral feeding. 5. The incidence of retrograde colonization was higher in patients with enteral feeding. 6. The incidence of nosocomial pneumonia were 30 and 40 percent, and there was no significant difference between the two groups. From our study, the incidence of nosocomial pneumonia was not different significantly between the two groups although gastric pH differed significantly.
APACHE ; Colon ; Enteral Nutrition ; Gastric Juice ; Hemorrhage ; Histamine* ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Intensive Care Units ; Intubation* ; Mortality ; Parenteral Nutrition, Total ; Pneumonia* ; Stomach ; Thorax ; Trachea ; Ulcer

No abstract available.
Humans

No abstract available.
Silicones*

Biliary cystadenoma is a rare biliary ductal neoplasm that usually arises in the liver and less frequently in the extrahepatic bile ducts. Clinical manifestations are non-specific; hence preoperative diagnosis depends heavily on imaging. Computed tomography, ultrasonography, angiography and cholangiogram are useful diagnostic procedures in biliary cystic tumor, but definite diagnosis depends on histologic diagnosis. Surgical resection often yields excellent results. Surgical procedures used to treat cystadenomas include: aspiration, drainage, marsupialization, and excision. If there is no evidence of metastasis, complete resection of these tumors is necessary for a complete cure. We experienced an 80-year-old man who complained of jaundice and RUQ pain. He was diagnosed as biliary mucinous cystadenoma, We confirmed our diagnosis by cholangioscopic biopsy, and performed endoscopic sphincterotomy(EST). So, we report this case and have reviewed the relevant literature as a part of our report for the subject case.
Aged, 80 and over ; Angiography ; Bile Ducts, Extrahepatic ; Biliary Tract* ; Biopsy ; Cystadenoma ; Cystadenoma, Mucinous* ; Diagnosis ; Drainage ; Humans ; Jaundice* ; Liver ; Mucins* ; Neoplasm Metastasis ; Pancreas* ; Ultrasonography

Spontaneous tumor rupture is a serious but rare complication of hepatocellular carcinoma (HCC) and has a low survival rate. Here, we report a case of massive HCC that ruptured and was treated successfully with transarterial chemoembolization (TACE). A 55-year-old man with abdominal pain was diagnosed with a 12-cm-wide ruptured HCC at segment 8. The overall liver function was scored as Child–Pugh A, but the single nodule tumor had ruptured; therefore, TACE treatment was initiated. After the first TACE treatment, residual tumors were found; thus, secondary TACE was performed 5 months later. No new lesions or extrahepatic metastases were found 16 months after the first TACE treatment, so hepatic resection was performed for curative treatment. The postoperative pathology results did not reveal any cancer cells; hence, TACE alone resulted in a cure. We report this case because the cure has been maintained for more than 3 years after resection.

Phase contrast magnetic resonance imaging techniques can be used to evaluate the to-and-fro motion of cerebrospinal fluid(CSF) throughout CSF pathways between the ventricles and subarachnoid space of the brain and spine. This CSF motion is due to transmitted cardiac pulsation from systolic expansion of the cerebral hemispheres. To cover the entire cardiac cycle, peripheral cardiac triggering was used. Using this technique, we analyzed quantitative CSF motion over a cardiac cycle to distinguish normal CSF flow from that seen in hydrocephalus. We tested the reproducibility of the aqueductal CSF signal intensity on a phase contrast cine MR sequence in 28 patients with normal ventricle. Sixteen patients with obstructive hydrocephalus and 11 patients with normal pressure hydrocephalus(NPH) were investigated with the sequence before and after CSF diversion. The peak CSF flow velocity in aqueduct was significantly increased in patients with NPH and significantly decreased in patients with obstructive hydrocephalus(NPH group: 6.71cm/sec, control group: 2.94cm/sec, obstructive group; less than 1.0cm/sec). After LP shunting in NPH group, retrograde flow signal curves were anterogradely converted and the peak flow velocities were somewhat decreased(mean: 5.10cm/sec). The clinical diagnosis of NPH was well correlated with the results of cine MRI. After endoscopic third ventriculostomy in obstructive group, we could note increased CSF flow velocity both at prepontine cistern and precordal subarachnoid space with markedly increased flow at prepontine cistern. Phase contrast cine MRI is useful in evaluatng the CSF dynamics in patients with hyperdynamic aqueductal CSF (NPH) or aqueductal obstruction(obstructive hydrocephalus).
Brain ; Cerebrospinal Fluid* ; Cerebrum ; Diagnosis ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Cine ; Spine ; Subarachnoid Space ; Ventriculostomy

BACKGROUND: The catheter ablation usin radiofrequency(RF) energy in patients with atrioventricular nodal reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT) ahs been proved as a safe and effective nonpharmacologic therapeutic modality. The purpose of our study was to evaluate the success rate and complications of the initial experience and to determine the extent of myocardial damage of RF catheter ablation. METHODS: Electrophysiologic study was performed with the standard technique. Twenty five patinents(M:F=16:9, mean age:42 years old) underwent RF catheter ablation in St. May's Hospital from April to December in 1994. The RF generator in this study was RFG-3D model and catheters were 6F or 7F steerable catheters with 4mm kistal tip. In order to evaluate the extent of myocardial damage the WBC count, LDH, CK, and CK-MB fraction were checked before and after RF catheter ablation and the Tc99m myocardial scintigraphy was performed within 72 hours of the porcedure. RESULTS: Six of twenty five patients had AVNRT, in which the success rate of selective ablation of the slow pathway was 83.8%. Nineteen patients with AVRT had one accessory pathway. The ablation success rate of 14 accessory pathways in left free wall location was 85.7%, and that of 3 in left posteroseptal location was 66.6%. Two right sided accessory pathways were not ablated successfully. The level of CK-MB fraction after ablation was within normal limit. Only one case revealed grade 2 of hot spot in Tc99m myocardial scintigraphy. CONCLUSION: The RF catheter ablation in patients with AVNRT and AVRT is a safe and effective nonpharmacologic therapeutic modality. But right sided accessory pathways are more difficult to ablate than left sided accessory pathways, requiring more experiences and better technique. The extent of myocardial damage after RF catheter ablation reveals relatively minimal by cardiac enzyme study and Tc99mmyocardial scintigraphy.
Catheter Ablation* ; Catheters ; Humans ; Myocardial Perfusion Imaging ; Radionuclide Imaging ; Tachycardia, Supraventricular*