BACKGROUND: Striatocapsular infarction involves the territory of the large lateral striate branches of the middle cerebral artery sparing the overlying cortex. Two kinds of angiographic findings of the striatocapsular infarction have been reported previously: one with a complete occlusion of the M1 segment and the other without. However, the clinical features and outcomes in relation to the magnetic resonance angiographic (MRA) findings remain unknown. In the present study, we evaluated the clinical outcomes in patients with striatocapsular infarctions according to the MRA findings. METHODS: Twenty-two consecutive patients with striatocapsular infarctions who were admitted to the Chosun University Hospital between July 1998 and June 2000 were included in the study. Striatocapsular infarction was confirmed by magnetic resonance imaging (MRI) and MRA. The patients were divided into two groups based on MRA findings. Ten patients with occluded MCA were included in group A, and the remaining 12 patients with normal or stenotic MCA were categorized as group B. We compared their clinical characteristics and outcomes at 3-months post-stroke. RESULTS: Only 1 out of 12 patients in group B and 6 out of 10 patients in group A showed cortical symptoms and signs. Patients in group A tended to have more severe disability and a worse prognosis than those in group B. CONCLUSIONS: The MRA findings may help clinicians to better predict the clinical outcomes after striatocapsular infarctions. (J Korean Neurol Assoc 19(5):452~456, 2001)
Humans ; Infarction* ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Prognosis

PURPOSE: To demonstrate the clinical usefulness of ultrasonography for detecting esophageal varices. MATERIALS AND METHODS: In 20 cases of esophaged varix, the authors analysed the transabdominal ultrasono-graphicfindings of the esophagogastric junction and compared mural thickness, the anteroposterior diameter of theesophagus, and the echogenic nature of the esophageal mucosal layer with those of 78 normal patients. RESULTS:The anterior and posterior mural thickeness of normal esophagus was 2.2 +/-0.7 and 2.4 +/-0.8mm re-spectively, butfor variceal esophagus, the corresponding readings were 5.9 +/-1.3 and 5.2 +/-1.3mm respective-ly. Theanteroposterior diameter of normal esophagus was 7.9 +/-2.1mm and that of variceal esophagus was 1 4 . 0 +/-1.8mm.There was a stastically significant difference (p<0.01) in mural thickness and anteroposterior diameter of theesophagus between a normal and variceal patient with regard to change of echogenic nature at the esphagogastricjunction. Normal esophageal mucosa showed a thin and uniform echogenic line, but for variceal mucosa, theechogenic pattern was irregular, tortuous and thick. CONCLUSION: The athors believe that transabdominal US ishelpful for detecting esophageal varices in patients with liver cirrhosis and UGI bleeding. Important clinicallyuseful sonographic findings in diagnosing e-sophageal varix are as follows: 1) mural thickness more than 6mm; 2)anteroposterior diameter of the esopha-gus of more than 15mm; 3) irregular, tortuous and thickened echogenicmucosa.
Esophageal and Gastric Varices* ; Esophagogastric Junction ; Esophagus ; Hemorrhage ; Humans ; Liver Cirrhosis ; Mucous Membrane ; Reading ; Ultrasonography ; Varicose Veins

Recent studies have revealed that IGF- I produced in kidney are of two fractions; GH dependent and GH nondependent IGF-I. The role of GH nondependent IGF-I is interesting in renal hypertrophy and glomerulosclerosis because GH is clearly related with hypertrophy accompanying glomerulosclerosis is not seen in GH deficient animal. The relationship of the high protein diet and the IGF- I production under the deprivation of GH was studied. In hypophysectomized Sprague-Dawley rat, the level of serum IGF-I was measured using radioimmunoassay, and renal IGF- I production evaluated by immunohistochemistry during both normal and high protein diet. Serum IGF-I of rats on high protein diet was significantly higher than that fed normal protein diet. After unilateral nephrectomy, the level of serum IGF-I was significantly increased in both normal and high protein diet groups. Henle's loop, distal convoluted tubule and collecting duct were weakly stained with normal protein diet. With high protein diet, the staining intensities increased at these portion , and distal part of proximal convoluted tubule and straight tubule were weakly stained. After unilateral nephrectomy, distal convoluted tubule and collecting duct were densely stained with normal protein diet. With high protein diet, the staining intensities increased in distal part of proximal convoluted tubule and Henle's loop. Regardless of the types of protein diet, the specific difference between unilateral nephrectomized rats and sham- operated rats was immunoreactivity of the distal convoluted tubule.. In conclusion, it is suggested that GH non-dependent IGF-I is mainly produced in distal convoluted tubule during compensatory renal hypertrophy, and protein diet mainly affect IGF- I production of distal part of proximal convoluted tubule and Henle's loop.
Animals ; Diet ; Growth Hormone* ; Hypertrophy ; Hypophysectomy ; Immunohistochemistry ; Insulin-Like Growth Factor I ; Kidney* ; Nephrectomy ; Radioimmunoassay ; Rats ; Rats, Sprague-Dawley

Since 1970, the group B streptococcus(GBS) has been a significant cause of neonatal sepsis in the West. Two distinct forms of disease occur in neonates. Early-onset disease which occurs within 7 days after birth is characterized by respiratory distress, apnea, shock, pneumonia, and occasionally meningitis. Late onset disease usually occurs at 3-4 weeks of age(ranging from 7 days to 3 months) and presents occult bacteremia or meningitis. The GBS is thought to be a rare causative agent for neonatal sepsis in Korea. Lately, we experience a case of early-onset GBS sepsis who died at 3rd day of life. We present this case with brief review of literatures.
Apnea ; Bacteremia ; Humans ; Infant, Newborn ; Korea ; Meningitis ; Parturition ; Pneumonia ; Sepsis* ; Shock

OBJECTIVE: The postoperative subsidence of anterior cervical interbody fusion for cervical degenerative diseases gives rise to segmental kyphotic collapse, screw loosening, and chronic neck pain. So, intraoperative custom-made polymethylmethacrylate (PMMA) C-cage has been developed to prevent subsidence following anterior cervical fusion. METHODS: A total of patients who underwent anterior cervical interbody fusion with a intraoperative custom - made cervical cage filled with local bone and demineralized bone matrix (group A) were analyzed prospectively from June 2004 to June 2005. These were compared with 40 patients who were treated with iliac bone graft (group B). We evaluated subsidence ratio, change of segmental angle, distraction length and segmental angle. Statistical analysis was performed using independent sample t-test and Pearson correlation coefficient. RESULTS: Group A had a statistically significant decrease in subsidence ratio (0.64+/-0.43%, p=0.00), distraction length (2.42+/-1.25 mm, p=0.02), and follow angle change (1.78+/-1.69degrees, p=0.01) as compared with Group B. However, there was no statistically significant difference in postoperative segmental angle change (p=0.66). On the analysis of the correlation coefficient, the parameters showed no interrelationships in the group A. On the other hand, subsidence ratio was affected by distraction length in the group B (Pearson correlation=0.448). CONCLUSION: This operative technique would be contributed for the reduction of a postoperative subsidence after the anterior cervical interbody fusion procedure for cervical disc disease with moderate to severe osteoporotic condition and segmental loss of lordosis.
Animals ; Bone Matrix ; Hand ; Humans ; Lordosis ; Neck Pain ; Polymethyl Methacrylate ; Prospective Studies ; Transplants

OBJECTIVES: Several studies have found a significant association between the presence of earlobe crease (ELC) and cardiovascular disease (CVD). Brachial-ankle Pulse Wave Velocity (baPWV) is a non-invasive and useful measure of arterial stiffness predicting cardiovascular events and mortality. However, few studies have reported the relationship between ELC and baPWV as a new measure of arterial stiffness. The purpose of this study was to determine whether ELC is related to baPWV in non-diabetic, non-hypertensive, and apparently healthy Korean adults. METHODS: A cross-sectional study was conducted on 573 non-hypertensive, non-diabetic Korean adults aged 20-80 yr. Subjects were stratified into three groups according to gender and menopausal status. baPWV was measured by an automatic waveform analyser. The association between ELC and baPWV was assessed by multiple linear regression analysis after adjusting for conventional cardiovascular disease risk factors including age, gender, blood pressure, lipid profile, and smoking status etc. RESULTS: The overall frequency of ELC was 19.02% and the subjects with ELC showed significantly higher mean baPWV (p<0.0001). Multiple linear regression of subjects revealed that the presence of ELC was independently associated with baPWV (male, p<0.0001; premenopausal female p=0.0162; postmenopausal female p=0.0208). CONCLUSION: ELC had a significant correlation with baPWV, independently controlling for other classical cardiovascular risk factors in adults aged 20 yr or older. ELC is an important surrogate marker of increased arterial stiffness as measured by baPWV in Korean adults.
Adult ; Aged ; Blood Pressure ; Cardiovascular Diseases ; Cross-Sectional Studies ; Female ; Humans ; Korea ; Linear Models ; Pulse Wave Analysis ; Risk Factors ; Smoke ; Smoking ; Vascular Stiffness ; Biomarkers

No abstract available.
Impetigo* ; Pregnancy*

BACKGROUND: To the emergency physician, issuing a death certificate is becoming a burden as the DOAs(Deaths on Arrival) have increased in recent years. We analyzed the agreement on the causes of death issued by emergency physicians and attempted to find out whether emergency physicians complied with the guidelines for issuing death certificates. MATERIAL AND METHOD: A survey questionnaire containing twelve pre-selected DOA cases which were supplemented with relevant past medical history and physical examination was used. The cases, with varying causes of death, were chosen from the medical records of DOA patients who presented to the emergency department at Severance Hospital, Yonsei University College of Medicine, from January 1997 to December 2000. The questionnaires were sent to 60 emergency physicians(22 specialists and 38 residents) at 22 university-affiliated teaching hospitals and 2 general hospitals across the nation. They were asked to identify the most probable direct cause of death for each of the 12 cases. The same questionnaire was sent to medical examiners at the National Institute of Scientific Investigation and to a Korean emergency physician at Albert Einstein College of Medicine in New York, USA. We also included an open question about the optimal age for the use of 'senility' as a cause of death. RESULTS: All 60 emergency physicians responded to the survey. The average number of causes of death per case was 9.7(7~14). The range of concordance of causes of death was 23.3% to 66.6%. Out of a total of 720 causes of death given by the emergency physicians, 35(4.9%) failed to adhere to the death certification guidelines. Also, 210 causes of death were not listed in the Korean classification of standard causes of death. Interestingly, the medical examiner answered 'unknown etiology' and the emergency physician in the USA answered 'cardiopulmonary arrest' or 'respiratory arrest' in most cases. Regarding 'senility' as a cause of death, 22 physicians(36.7%) thought the optimal age was over 80 years. CONCLUSION: A significant lack of agreement exists in determining the cause of death for the DOA patients arriving at emergency departments. Therefore, an all-out effort is essential to find ways to improve and resolve this situation. As the death certificate is a legal document and a basis for vital statistics, emergency physician should seek a rational consensus to improve and resolve these inconsistencies.
Cause of Death* ; Certification ; Classification ; Consensus ; Coroners and Medical Examiners ; Death Certificates* ; Emergencies ; Emergency Service, Hospital ; Hospitals, General ; Hospitals, Teaching ; Humans ; Medical Records ; Physical Examination ; Surveys and Questionnaires ; Specialization ; Vital Statistics

Dysphagia is a common symptom in elderly individuals, and anterior cervical osteophytes have been implicated as a rare, but surgically correctible cause of dysphagia. In previous studies, surgical treatment of such cases has been associated with immediate symptomatic relief. The surgical outcome of three cases was reviewed retrospectively. A 74-year-old male with progressive dysphagia and aspiration pneumonia attributed to diffuse ossification of anterior longitudinal ligaments (OALL) from C3 to T1 was treated by standard anterior approach and subtotal resection was done. The second case was a 64-year-old male with dysphagia due to diffuse idiopathic skeletal hyperostosis (DISH) underwent anterior DISH resection. The last was a 79-year-old male with progressive dysphagia and aspiration pneumonia due to OALL treated with osteophyte resection. Symptomatic relief was achieved immediately in the first two cases, however, recurrence occurred after seven years in the first case and osteophyte regrowth without symptom in the second case after 33 months follow up. The last case did not have any symptomatic improvement and mechanical obstruction was noted intraoperatively within esophagus. Surgical complication resulting emergency hematoma evacuation and tracheostomy occurred in the second case with complete recovery. Surgical complications, reossification with symptomatic recurrence, and possible plural or mixed causes of dysphagia are all reasons for caution prior to the decision to intervene surgically in such cases.
Aged ; Cervical Vertebrae ; Deglutition Disorders ; Emergencies ; Esophagus ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; Longitudinal Ligaments ; Male ; Middle Aged ; Osteophyte ; Pneumonia, Aspiration ; Recurrence ; Retrospective Studies ; Tracheostomy

No abstract available.