Sinking skin flap syndrome is defined by a series of neurological symptoms with skin depression at the site of cranial defect. We experienced neurological improvement in a patient with markedly sunken craniectomy site after ventriculoperitoneal shunt (V-P shunt) clamping operation. A 17-year old female patient was in vegetative state and spastic quadriplegia after traumatic brain injury. She was suffered from frequent vomiting. To evaluate central nervous system problem we checked brain computed tomography which showed that right frontotemporoparietal craniectomy area was markedly sunken and midline was shifting to the left. After V-P shunt clamping operation, craniectomy site was elevated and midline shifting was improved. Vomiting was disappeared. Coma Recovery Scale-revised (CRS-R) score was improved from 3 to 6.

BACKGROUND: The laparoscopic cholecystectomy (LC) has been accepted as the procedure of choice for chronic cholecystitis. However in cases of acute cholecystitis, the safety and the efficacy of LC has not been fully determined. Thus we performed this study to assess the clinical outcomes of a LC for acute cholecystitis to evaluate it's efficacy and safety. METHODS: The authors retrospectively analyzed 1,164 LCs performed in Yeungnam University Hospital from May 1991 to March 1996. Among the 1,164 LCs, 118 were performed for acute cholecystitis and 1,046 were performed for chronic cholecystitis. The authors compared the mean operation time, the conversion rate to an open cholecystectomy (OC), the reasons for conversion, the complication rate, the postoperative hospital stay, and the postoperative use of analgesics between the patients with acute cholecystitis and the patients with chronic cholecystitis. RESULTS: In the 1046 patients with chronic cholecystitis, the mean operation time was 55.9 minutes, the conversion rate to an OC was 2.7%, the complication rate was 4.0%, the mean postoperative hospital stay was 3.3 days, and analgesics were used in 48% of the patients. However in the 118 patients with acute cholecystitis, the mean operation time was 65 minutes, the conversion rate to an OC was 11.8%, the complication rate was 16.9%, the mean hospital stay was 4.4 days, and analgesics were used in the 60% of the patients. Also the authors found that the longer duration of preoperative symptoms and an advanced state of inflammation (e.g., GB empyema or gangrenous changes) were the two most common causes of conversion to an OC in the case of acute cholecystitis. Although all the analyzed parameters (especially, the conversion rate and the complication rate) were higher in the patients with acute cholecystitis than they were in the patients with chronic cholecystitis, a LC for acute cholecystitis seems to be acceptable because there were no mortalities and there were no life threatening complications. CONCLUSIONS: From, the aspects of safety and efficacy, a LC can be performed in most patients with acute cholecystitis. However, it should be remembered that the prolonged duration of symptoms prior to a LC increases the conversion rate to O.C. and if we confront the advanced cholecystitis (GB empyem or gangrenous change) with difficult Calot's triangle during a L.C., early conversion to an OC should be considered.
Analgesics ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Empyema ; Humans ; Inflammation ; Length of Stay ; Mortality ; Retrospective Studies

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Arteries ; Bradycardia ; Catheters ; Coronary Vessels ; Humans ; Hypotension ; Stents

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Arteries ; Bradycardia ; Catheters ; Coronary Vessels ; Humans ; Hypotension ; Stents

PURPOSE: This study was conducted to analyze the efficacy of photoselective vaporization of the prostate (PVP) with the use of a 980 nm diode laser for benign prostatic hyperplasia (BPH) according to postoperative period. MATERIALS AND METHODS: Data were collected from 96 patients who were diagnosed with BPH and who underwent PVP with the 980 nm K2 diode laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and post-void residual volume (PVR), were assessed and compared with preoperative baseline values. RESULTS: The mean prostate volume was 45.3+/-15.6 g, the mean operative time (lasing time) was 22.9+/-18.3 minutes, the total amount of energy was 126+/-84 kJ, and the Foley catheter maintenance period after PVP was 24.8+/-5.6 hours. At 1 month, significant improvements were noted in IPSS (11.7+/-6.6), QoL score (2.3+/-1.1), Qmax (12.7+/-6.1 ml/sec), and PVR (41.9+/-30.5 ml). After 3 months, all follow-up parameters showed significant improvements that were sustained throughout a period of 6 months after PVP. CONCLUSIONS: PVP using a K2 diode laser is a minimally invasive and effective surgical method for improvement of BPH and is associated with minimal morbidity.
Catheters ; Follow-Up Studies ; Humans ; Lasers, Semiconductor ; Operative Time ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Residual Volume ; Urodynamics ; Volatilization

In this study, we examined rabbit gastric ulcer models that can serve as more clinically relevant models. Two types of ulcer model were studied: acetic acid-induced ulcers (AAU) and mucosal resection-induced ulcers (MRU). For AAU, rabbit gastric mucosa was exposed by median laparotomy and treated with bottled acetic acid. MRU was examined as a model for endoscopic mucosal resection (EMR). Normal saline was injected into the submucosal layer and the swollen mucosa was resected with scissors. Endoscopic mucosal resection (EMR) is frequently performed for treatment of early gastric cancers. This procedure inevitably leads to ulcers and bleeding. Bleeding control is the major concern in endoscopic mucosectomy, and some endoscopic hemostatic agents are currently under clinical and preclinical studies. MRU was developed as a model for these induced ulcers and the evaluation of the healing process. The clinical relevancy of those models was compared with that of rat models. Progressive healing was observed for 7 days based on histology. Rabbit models demonstrate round, deep ulcers with clear margins and well-defined healing stages that were difficult to define in rat models.
Acetic Acid ; Animals ; Gastric Mucosa ; Hemorrhage ; Laparotomy ; Mucous Membrane ; Rats ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer

BACKGROUND: Medication adherence is important for hypertension management but still stay low level. It is reasonable method to classify medication nonadherence into intentional nonadherence and unintentional nonadherence and manage it according to this categories. This study aimed to explore medication adherence and its predictors in community patients with hypertension, especially dividing into intentional nonadherence and unintentional nonadherence. METHODS: Study subjects included 1,988 patients who were prescribed hypertension drugs among 2012 community health survey subjects of 10 cities in Gyeongsangnamdo and we analyzed medication adherence with hypertension and its predictors. We conducted chi-square test for nominal variable and ANOVA test for continuous variable and use multinominal regression to analyze independent predictors of intentional nonadherence and unintentional nonadherence in contrast to medication adherence. RESULTS: Of the 1,988 patients, 49.7% were adherent, 26.1% were unintentionally nonadherent and 24.2% intentionally nonadherent. Independent predictors of unintentional nonadherence were depressive symptoms (odds ratio [OR]=1.696, P=0.047) and arthritis (OR=1.319, P=0.030) and independent predictors of intentional nonadherence were cardiocerebrovascular disease (OR=1.464, P=0.044), self-efficacy (OR=0.984, P=0.007), beliefs about medications questionnaire (necessity [OR=0.834, P<0.001] and concern [OR=1.236, P<0.001]). CONCLUSIONS: In order to manage hypertension in community, improvement in medication adherence is needed. Depressive symptom and self-efficacy need to be managed, but especially patients'beliefs about their medication need to be considered to improve intentional nonadherence.
Aged* ; Arthritis ; Depression ; Gyeongsangnam-do ; Health Surveys ; Humans ; Hypertension* ; Intention ; Medication Adherence*

The rhizomes of Dioscorea japonica Thunb. are widely consumed as food and also used to treat diabetes and polyuria in Korea. This study was undertaken to study the anti-atopic dermatitis effects of a 95% ethanolic extract (DJE) of D. japonica in an oxazolone-stimulated murine model of atopic dermatitis (AD). The therapeutic effects of DJE on AD-like skin lesions were assessed on both ears. DJE (1%) or dexamethasone (0.5%; the positive control) were applied to skin lesions for three weeks. Serum levels of IgE and IL-4 were assessed by ELISA (enzyme-linked immunosorbent assay). Histopathological examinations were performed by hematoxylin and eosin (H&E) and toluidine blue staining and revealed DJE significantly reduced dermal thickness and inflammatory cell infiltration when applied to oxazolone-treated ear skin. DJE-treated AD mice also showed lower serum levels of IgE and IL-4 than oxazolone-stimulated controls. Our findings demonstrate DJE might be a useful safe, topical agent for the treatment of atopic diseases.
Animals ; Dermatitis ; Dermatitis, Atopic ; Dexamethasone ; Dioscorea ; Ear ; Enzyme-Linked Immunosorbent Assay ; Eosine Yellowish-(YS) ; Ethanol ; Hematoxylin ; Immunoglobulin E ; Interleukin-4 ; Korea ; Mice ; Oxazolone ; Polyuria ; Rhizome ; Skin ; Therapeutic Uses ; Tolonium Chloride

The outward currents elicited in hamster eggs by depolarizing pulses were studied. The currents appeared to comprise at least two components, a transient outward component (Ito) and a steady-state outward component (Iinfin). Ito was transiently followed by the cessation of inward Ca2+ current (ICa), and its current-voltage (I-V) relation was a mirror image of that of ICa. Either blockade of ICa by Co2+ or replacement of Ca2+ with Sr2+ abolished Ito without change in Iinfin. Intracellular EGTA (10 mM) inhibited Ito but not Iinfin. suggesting strongly that generation of Ito requires intracellular Ca2+. Apamin (1 nM) abolished selectively Ito, indicating that Ito is Ca2+-dependent K+ current. On the other hand, Iinfin was Ca2+-independent. Both Ito and Iinfin were completely inhibited by internal Cs+ and external TEA. The estimated reversal potential of Ito was close to the theoretical EK. Taken together, both outward currents were carried by K+ channels. From these results, Ito is likely to be a current responsible for the hyperpolarizing responses seen in hamster eggs at fertilization.
Animals ; Apamin ; Cricetinae* ; Eggs ; Egtazic Acid ; Fertilization ; Hand ; Oocytes* ; Ovum ; Tea

Lobelia chinensis Lour. has commonly been used in traditional Chinese medicine for the treatment of antidote, diuretic, diarrhea, and inflammation. This study aimed to identify the active compounds in an aqueous extract of L. chinensis responsible for its anti-atopic effect in vitro using RBL-2H3 cells. A chemical investigation of secondary metabolites in an aqueous extract of L. chinensis led to the isolation of nine chemical constituents, which included the four marker compounds, and these were evaluated for their inhibitory effects on IL-4 mRNA expression and the release of β-hexosaminidase in propidium iodide-induced RBL-2H3 cells. We found diosmetin and fraxidin inhibited cellular IL-4 mRNA expression, and that diosmetin and 6,8-dimethoxycoumarin inhibited DNP-specific IgE-induced degranulation in these cells. Our study suggests that diosmetin, fraxidin, and 6,8-dimethoxycoumarin are potential candidates for the treatment of atopic diseases.