No abstract available.
Fingers* ; Replantation* ; Transplants*

No abstract available.
Fingers* ; Replantation* ; Transplants*

BACKGROUND: Dizziness is a common complaint in patients presenting to the emergency room and that has various pathologic causes. This study investigate the clinical differences in dizziness between the central origin and the peripheral origin and to provides the clues far diagnosis and proper treatment. METHODS: We analysed 290 patients with dizziness during 12 months period prospectively, who visited in ED, Inha University Hospital from Jan. 1997 to Dec. 1997. We analysized sex ratio, characteristics of the dizziness, associated past illness, associated symptoms, severity, results of the special radiologic study, nystagmus type, and causes of central origin and peripheral origin dizziness. RESULTS: Male to female ratio was 1:1.4 in central origin(n=165) and 1:2.0 in peripheral origin(n=125). Most common age group was 11th decade in both groups. According to the characteristics of the dizziness, rotation sense was the main complaint of the peripheral origin dizziness. Most common past illness was hypertension in both groups. MRI has diagnostic priority than CT scan in central origin dizziness. Types of nystagmus has some significant differences between two groups. CONCLUSION: Dizziness may represented as a sign of significant pathological neurologic status especially in central origin. So we must precisely evaluate the patient history, neurologic examination of the inner ear and CNS, and special radiologic study incliding MRI.
Diagnosis ; Dizziness* ; Ear, Inner ; Emergency Service, Hospital ; Female ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Neurologic Examination ; Prospective Studies ; Sex Ratio ; Tomography, X-Ray Computed

Carotidynia is defined as an atypical craniofacial pain syndrome caused by the dilatation or distension of the extracranial arteries. We report an unusual case of carotidynia mimicking trigeminal neuralgia caused by an arterioscle-rotic tortous carotid artery. A 68-year-old woman suffered from frequent episodes of severe electrical shock-like radiating pain around her left ophthalmic and maxillary division of the trigeminal nerve for 5 years. Initially, under the impression of trigeminal neuralgia, carbamazepine was tried. She was reevaluated due to an unsatisfactory pharmacological response. On examination, no abnormalities were found on the craniofacial region except for a tortous pulsating tender mass on the region of the left carotid artery. Routine laboratory findings and a connective tissue study were normal. Neck sonography and a 4-vessel angiography showed a tortous left internal carotid artery with stenosis extending near to the skin. The patient was treated for 2 weeks with a nonsteroidal anti-inflammatory agent, steroids, a prophylctic beta blocker, and a TCA antidepressant. The pain gradually subsided.
Aged ; Angiography ; Arteries ; Carbamazepine ; Carotid Arteries ; Carotid Artery, Internal ; Connective Tissue ; Constriction, Pathologic ; Dilatation ; Facial Neuralgia ; Female ; Humans ; Neck ; Skin ; Steroids ; Trigeminal Nerve ; Trigeminal Neuralgia*

We experienced one case of severe pituitary dwarfism in a 10 years old female girl. Magnetic resonance image (MRI) revealed transection of the pituitary stalk stalk with the formation of high intensity ectopic posterior lobe located at the median eminence and agenesis of an anterior lobe of pituitary gland. The serum growth Hormone (GH) response to clonidine and L-dopa revealed severe GH deficiency. The patient had responses to TRH, normal TSH and partial prolactin response, respectively. There was not response LH and FSH to GnRH. The morning cortisol concentration and serum T4 concentration were decreased below the normal range. These findings and no hyperprolactinemia suggested the presence of a vascular connection between the pituitary gland and hypothalamus, which is not visible on MRI. Sofar, the primary cause of idiopathic pituitary dwarfism in many patients is injury to hypothalamus by perinatal insults. In this patient, there was no history of perinatal insults and postnatal head trauma but transection of the pituitary stalk. We report a case of severe pituitary dwarfism due to agenesis with brief review of related litereature.
Child ; Clonidine ; Craniocerebral Trauma ; Dwarfism, Pituitary* ; Female ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Hypothalamus ; Levodopa ; Magnetic Resonance Imaging ; Median Eminence ; Pituitary Gland* ; Pituitary Gland, Anterior* ; Prolactin ; Reference Values

The study wasdesigned for the evaluation of diagnostic usefulness of standard electro-oculography (EOG) battery in differentiating the vertigo of central origin from that of peripheral one. Twelve patients of definite posterior fossa lesion proved by MRI or CT scan were selected as a central group and fourteen patients of peripheral vestibulopathy as a peripheral group. Using our laboratory standard methods of EOG battery, age-matched normal valuse of bithermal caloric responses(fixation supperssion, vestibular paresis, and directional preponderance) and the gains of pursuit and optokinetic nystagmus were obtained. Abnormal vestibular paresis was found in 21 patients of the peripheral group, but in only one patient of the central. Directional preponderance did not show significant difference between the peripheral and central group (p<0.01). In peripheral group, the fixation suppression index (percent change in slow-phase velocity with visual fixation during the period of maximum intensity of caloric nystagmus) was 56.8+8.3%, p>0.01). However, failure of fixation suppression was noted in eleven patients of central group and its mean value of 92.6+7.3%, which was significant statistical difference compared with peripheral and control group (p<0.01 respectively). Defective suppression of caloric nystagmus was more remarkable when the direction of caloric nystagmus was induced toward the lesion site. Such findings were demonstrated in six patients of eight patients with definits unilateral cerebellar hemispheric lesions. In addition, the gains of pursuit and optokinetic nystagmus were significantly reduced in the patients showing defctive fixation suppression compared with whom showed normal pattern of fixation suppression (p<0.01). Therefore, fixation suppression, vestibular paresis, and the gains of pursuit and optokinetic nystagmus would be useful diagnostic paremeters in differntiaging the vertigo of central origin from that of the peripheral.
Electrooculography ; Humans ; Magnetic Resonance Imaging ; Nystagmus, Optokinetic ; Nystagmus, Physiologic ; Paresis ; Tomography, X-Ray Computed ; Vertigo*

No abstract available.
Acromioclavicular Joint* ; Acromion* ; Dislocations*

Staphylococcus species are one of prevalent pathogens found in hospitals. Microbes that are a primary cause of nosocomial infection were isolated from a dental and medical environment it may assist the reader to explain what this is and how it differs from the 'dental health care providers and ward health care providers'. To investigate the distribution of staphylococcus species in this environment, we used vitek II to measure drug sensitivity, and further performed biochemical testing. The isolation rate of staphylococcus species from the dental and medical environment was 100% but from dental health care providers and ward health care providers were 44.4% and 33.3%, respectively. In the analyses, staphylococcus species showed resistance to diffusion of cefoxitin and oxacillin discs. These staphylococci may be sufficiently positive for the mecA gene. Our results suggest that staphylococci might be an important cause of nosocomial infection in the dental clinic.
Adenosine ; Anti-Infective Agents ; Cefoxitin ; Cross Infection ; Delivery of Health Care ; Dental Clinics ; Diffusion ; Health Personnel ; Humans ; Oxacillin ; Staphylococcus

This case, a 15-year-old female, is peculiar because she had more numerous characteristic lesions of tuberous sclerosis than other previous cases in Korea. In addition to the typical triad of tuberous sclerosis, she had shagreen patches, cafe-au-lait spot, angiomyolipomas in both kidneys, phacomas in both eyes, periventricular calcifications, and hydrocephalus due to a mass around the foramen of Monro. Biopsy, taken after complete removal of a mass around the foramen of Monro, revealed hamartoma which was made up of subependymal giant cell astrocytoma, gliosis, and spongioblastoma. With reviewing some of literatures, we present a case of the tuberous sclerosis.
Adolescent ; Angiomyolipoma ; Astrocytoma ; Biopsy ; Cafe-au-Lait Spots ; Cerebral Ventricles ; Female ; Gliosis ; Hamartoma ; Humans ; Hydrocephalus ; Kidney ; Korea ; Neuroectodermal Tumors, Primitive ; Tuberous Sclerosis*

Maspin is a recently described gene with tumor suppressor activity. The gene product is a 42 kD protein with homology to the serpin family of protease inhibitors and may play a role as an inhibitor of tumor cell invasion. The prior observation that invasive breast cancers and their metastases showed decreased maspin protein expression by immunostaining supports this speculation. However, the role of maspin in breast cancer progression has not been studied in detail. We, therefore, studied maspin protein expression in a series of hyperplasia, atypical ductal hyperplasia, intraductal carcinoma and invasive carcinomas. Immunohistochemical staining (IHC) for maspin was performed on paraffin sections of 136 breast specimens using a commercially available monoclonal antibody. Among the 106 cases studied were 36 moderate/florid ductal hyperplasia, 11 atypical ductal hyperplasia (ADH), 29 intraductal carcinoma (IDC) (4 low grade, 13 intermediate grade, 12 high grade) and 30 invasive ductal carcinomas. Thirty cases of normal breast were also studied as control group. IHC stains were scored using a semiquantitative scoring system. The mean IHC scores for maspin for normal, moderate/florid hyperplasia, atypical ductal hyperplasia, intraductal carcinoma, and invasive carcinoma were 5.51 1.30, 7.36 0.72, 3.82 1.60, 4.48 2.69, 3.97 3.30, respectively. These scores for each category were statistically significant (p<0.05), except between ADH and IDC. Maspin protein expression was increased in most cases of moderate/florid hyperplasia, while maspin expression was more heterogeneous in ADH and IDC. In high grade IDC, maspin protein expression was stronger than low and intermediate grade IDC, and this suggests the possibility of a compensatory cellular response against the forces driving further tumor progression. Two thirds of invasive ductal carcinomas expressed maspin protein weakly and focally. All metastatic carcinomas of lymph nodes were negative for maspin. It is possible that high grade IDC with strong maspin expression may represent a subset less likely to progress to invasive cancer. This speculation merits investigation in clinical outcome studies.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Coloring Agents ; Humans ; Hyperplasia* ; Lymph Nodes ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Paraffin ; Protease Inhibitors