We report a monozygotic twins with temporal lobe epilepsy, almost concordant in the onset time of firt seizure, lateralization and localization of epileptiform discharges. Partial seizures with secondarily generalized seizure occurred 15 days apart. EEG showed frequent spike-slow wave complexes on the right temporal area but the findings of brain MRI were normal in both. Past medical, delivery, developmental and family history were unremarkable. They had no physical and mental handicaps, and any other underlying causes of epilepsy. They have been on monotherapy with seizure free, although follow up EEG showed frequent spike-slow wave complexes after medication. As seizures developed simultaneously, the localization and lateralization of epileptiform discharges were concordant in our monozygotic twins, we suggest that genetic factor might be the most probable etiology of epilepsy in our cases but needs to be elucidated.
Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Follow-Up Studies ; Humans ; Seizures ; Temporal Lobe ; Twins, Monozygotic

PURPOSE: Midurethral sling procedure has become one of the most commonly performed procedures for the treatment of female stress urinary incontinence(SUI). Although complication rate is very low, some patients are required further treatment to correct unwanted problems after surgery as it continues to be more widely used. We evaluated the mesh-related complications in those who required further procedures after midurethral sling procedures. MATERIALS AND METHODS: From January 2000 to December 2005, female patients who underwent additional surgery because of complications after midurethral sling procedures for stress urinary incontinence were evaluated in this study. RESULTS: In 675 patients, 298 received a tension-free vaginal tape(TVT) and 377 received a Monarc(transobturator route, TOT) as a sling material at 3 different hospitals. 34(5.0%) out of 675 patients required additional surgery to correct complications including obstructive voiding symptoms, mesh extrusion, failed or recurred SUI, wound pain and mesh in the bladder. Mean age of 34 patients was 54.7, and TVT was used in 21(7.0%) out of 298 patients, Monarc was used in 12(3.4%) out of 377 as midurethral sling materials. In 19 patients who showed obstructive voiding symptoms, all were cured by mesh cutting and in 8 patients who complained of immediate recurrence of SUI, 7 showed complete dryness by shortening the loosen mesh. Mesh extrusion with vaginal erosion were observed in 3 and all were cured by segmental resection of mesh without recurrence of SUI. 2 patients who showed recurrence of SUI after 2 years of TVT received Monarc procedure. Mesh in the bladder which was found after 6 months of TVT was managed by endoscopic resection of mesh with Monarc procedure in 1, and suprapubic pain after TVT was improved by resection of TVT segment through suprapubic incision in 1. All reoperation procedures were performed by local anesthesia except 1(mesh in the bladder). CONCLUSION: These data demonstrate that midurethral sling is an excellent surgical procedure with low complication rate, high success rate in reoperation. However, care must be taken to reduce reoperation rate in applying tension of mesh on urethra because most patients(27 out of 34) who required reoperation have complained of obstructive voiding symptoms(19) and persistent incontinence(8).
Anesthesia, Local ; Female* ; Humans ; Recurrence ; Reoperation* ; Suburethral Slings* ; Urethra ; Urinary Bladder ; Urinary Incontinence* ; Wounds and Injuries

PURPOSE: The purpose of this study was to describe technological development, caring attributes and professional self-concept as perceived by nurses in YanBian. METHOD: Data were collected using an instrument containing 137 Likert items was administered to 477 RN's working in general hospitals in YanBian. The instrument contained sections which examined technological influences questionnaire(TIQ), caring attributes questionnaire(CAQ), and professional self-concept nursing inventory(PSCNI). RESULT: Descriptive and inferential statistics revealed by marital status and position. Married, working special ward nurses reported a higher TIQ score than that of unmarried and working general ward and OPD. PSCNI and CAQ score of head or supervisor nurses were higher than that of staff nurses. Subjects revealed very low score of CAQ, while PSCNI score was higher than that of other Asian countries such as Korea, Beijing China, HongKong China and Japan as proved in former study. CONCLUSION: Useful information for educators and nurse administrators is provided from this results. Further study needs to be done to discuss in the light of cultural and environmental differences between YanBian(Korean-Chinese) and Korean nurses.

PURPOSE: The aim of this study was to confirm the factors that affect the mortality associated with the open surgical repair of ruptured abdominal aortic aneurysm (rAAA) and to analyze the long-term survival rates. METHODS: A retrospective review was performed on a prospectively collected database that included 455 consecutive patients who underwent open surgical repair for AAA between January 2001 and December 2012. We divided our analysis into in-hospital and postdischarge periods and analyzed the risk factors that affected the long-term survival of rAAA patients. RESULTS: Of the 455 patients who were initially screened, 103 were rAAA patients, and 352 were non-rAAA (nAAA) patients. In the rAAA group, 25 patients (24.2%) died in the hospital and 78 were discharged. Long-term survival was significantly better in the nAAA group (P = 0.001). The 2-, 5-, and 10-year survival rates of the rAAA patients were 87%, 73.4%, and 54.1%, respectively. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–.08; P < 0.001) and aneurysm rupture (HR, 1.96; 95% CI, 1.12–.44; P = 0.01) significantly affected long-term survival. CONCLUSION: Preoperative circulatory failure is the most common cause of death for in-hospital mortality of rAAA patients. After excluding patients who have died during the perioperative period, age is the only factor that affects the survival of rAAA patients.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Cause of Death ; Hospital Mortality* ; Humans ; Mortality ; Perioperative Period ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Rupture ; Shock ; Survival Rate

Laryngopharyngeal reflux disease (LPRD) is common in laryngologic practice. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. Major symptoms of LPRD include hoarseness, cough, reflux symptom and mild dysphagia. Even though LPRD is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. In Recent study, 66.4% of Patient who has LPRD also associated with esophageal motility disorders. Esophageal achalasia is a disease of unknown etiology characterized by an absence of peristalsis in the body of esophagus and nonrelaxing hypertension of the lower esophageal sphincter. Common cause is loss of ganglion cells in Auerbachs plexus. The classic triad of symptoms in achalasia includes dysphagia, regurgitation and weight loss. LPRD and esophageal achalasia have similar symptoms but have different treatment of choice. The Differentiation diagnosis of theses disease is important and should be established by history, radiologic examination and endoscopic examination. We recently assessed a 59-year-old female patient who complained of an epigastric pain, dysphagia and chronic cough. LPRD was initially diagnosed on Laryngoscopic examination and Reflux Symptom Index, but patient was not relieved of any symptoms after treatment of Proton Pump Inhibitor for 3 months. After high resolution manometry, esophageal achalasia was finally diagnosed. We report this case regarding the diagnosis and treatment with review of literatures because we have to think about esophageal motility disorders as a differential diagnosis in laryngology.
Cough ; Deglutition Disorders ; Diagnosis ; Diagnosis, Differential ; Esophageal Achalasia* ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower ; Esophagus ; Female ; Ganglion Cysts ; Hoarseness ; Humans ; Hypertension ; Korea ; Laryngopharyngeal Reflux* ; Manometry ; Middle Aged ; Myenteric Plexus ; Otolaryngology ; Peristalsis ; Proton Pumps ; Weight Loss

BACKGROUND AND OBJECTIVES: Various techniques of ossicular reconstruction have been advocated for hearing restoration in the chronic otitis media and cholesteatoma. Although cartilage has good biocompatibility to minimize extrusion or displacement, and is readily available, versatile to use, the hearing results with cartilage graft are poorer than that with plastic materials. The author believed this was due to the sculpturing problem of cartilage, and has devised an assembled type of cartilage ossiculoplasty of PORP and TORP configuration. The technique and short term results are reviewed. METHODS: Of the patients who underwent ossiculoplasty between 1998 and 2000, 103 ears of 95 patients, aged 3-66 years (mean 38.9) were analysed retrospectively. The follow-up period was from 3 to 30 months (mean 9.5). Fifty-one ears were found to be in the second stage and 52 ears were in the first stage. Allograft septal cartilage was sculptured separately and assembled as head and shaft. The average threshold in the frequencies of 500, 1000 and 2000 Hz was used for determination of results. RESULTS: The preoperative mean air-bone gap (ABG) was 42.86+/-8.79 dB and postoperative ABG was 21.22+/-11.33 dB. Gain of ABG was 21.63+/-11.11 dB. Closure of the ABG to within 10 dB, 20dB and 30 dB were achieved in 25.24%, 55.34% and 83.50% respectively. Gain of the ABG did not differ between the one staged and the two staged ossiculoplasty. Patency of eustachian tube orifice and presence of superstructure of stapes did influence the hearing results of this type of ossiculoplasty. CONCLUSION: The assembled type of cartilage ossiculoplasty of PORP and TORP configuration with allograft septal cartilage ossiculoplasty shows satisfactory short term hearing results and represents an excellent alternative to biocompatible prosthesis for ossicular recon-struction.
Allografts* ; Cartilage ; Cholesteatoma ; Ear ; Eustachian Tube ; Follow-Up Studies ; Head ; Hearing* ; Humans ; Ossicular Prosthesis* ; Ossicular Replacement ; Otitis Media ; Plastics ; Prostheses and Implants ; Retrospective Studies ; Stapes ; Transplants

A death certificate (DC) can be considered a legal document and in terms of societal use, it is a public document. A DC includes facts such as the time and place of death, as well as judgments as to the cause and manner of death. Whether it pertains to facts or judgments, recording false information results in a false DC. According to the National Association of Medical Examiners (NAME) in the United States, it is acknowledged that there are varying opinions and approaches when it comes to classifying the manner of death. Therefore, it may require a final judgment, including input from the legal system. Generally, deaths resulting from complications that occur during drug administration or medical procedures are classified as natural deaths, while deaths due to unforeseen complications that occur suddenly, are categorized as accidental deaths. Applying this classification by NAME to the principles and legal precedents related to the duty of explanation and medical lowas of the Korean Medical Association, it is reasonable to classify deaths resulting from complication, during medical care, as natural death. However, if the death occurs due to injury or poisoning during medical care, it falls under external causes, according to the principle of following the primary cause. In conclusion, it is considered reasonable to classify complications that occur during medical treatment as natural deaths when they are foreseeable and within the accepted range of complications determined by medical standards at that the time.

PURPOSE: To understand the involvement of BRCA1 gene in Korean breast and/or ovarian cancer families. MATERIALS AND METHODS: Germline mutations of BRCA1 gene were analyzed in 13 families which included 3 hereditary site-specific breast cancer families, 6 suspected breast cancer families, and 3 suspected breast-ovarian cancer family, and one Li-Fraumeni family by screening BRCA1 gene using single strand conformation polymorphism (SSCP) analysis on polymerase chain reaction (PCR) amplified genomic DNA and confirmed the results by sequencing. RESULTS: Including one family with previously reported nonsense mutation of BRCA1 gene, we detected two mutations in unrelated families. One newly identified mutation was frame shift mutation resulting from TG deletion in codon 1701, which results in a truncated BRCA1 protein, at codon 1714. CONCLUSION: The proportion of families who inherit the mutated BRCA1 gene seems to be small among Korean breast and/or ovarian cancer families.
BRCA1 Protein ; Breast Neoplasms ; Breast* ; Codon ; Codon, Nonsense ; DNA ; Frameshift Mutation ; Genes, BRCA1* ; Germ-Line Mutation* ; Humans ; Mass Screening ; Ovarian Neoplasms* ; Polymerase Chain Reaction

PURPOSE: Alagille syndrome is a complex hereditary disorder that is associated with cardiac, hepatic, skeletal, ocular, and facial abnormalities. Mutations in the Notch signaling pathway, such as in JAG1 and NOTCH2, play a key role in embryonic development. A cardiac or hepatic presentation is a critical factor for determining the prognosis. METHODS: We conducted a retrospective study of 41 patients with Alagille syndrome or a JAG1 mutation between 1983 and 2013. RESULTS: The first presentations were jaundice, murmur, cyanosis, and small bowel obstruction at a median age of 1.0 months (range, 0-24 months). The JAG1 mutation was found in 27 of the 28 genetically-tested patients. Cardiovascular anomalies were identified in 36 patients, chronic cholestasis was identified in 34, and liver transplantation was performed in 9. There was no significant correlation between the severity of the liver and cardiac diseases. The most common cardiovascular anomaly was peripheral pulmonary stenosis (83.3%), with 13 patients having significant hemodynamic derangement and 12 undergoing surgical repair. A total bilirubin level of >15 mg/dL with a complex surgical procedure increased the surgical mortality (P=0.022). Eight patients died after a median period of 2.67 years (range, 0.33-15 years). The groups with fetal presentation and with combined severe liver and heart disease had the poorest survival (P<0.001). CONCLUSION: The group with combined severe liver and heart disease had the poorest survival, and a multidisciplinary approach is necessary to improve the outcome.
Alagille Syndrome* ; Bilirubin ; Cardiovascular Diseases ; Cholestasis ; Cyanosis ; Embryonic Development ; Female ; Heart Diseases ; Hemodynamics ; Humans ; Jaundice ; Labor Presentation ; Liver ; Liver Transplantation ; Mortality ; Pregnancy ; Prognosis ; Pulmonary Valve Stenosis ; Retrospective Studies

A 49-year old man who had been treated for five months at a private clinic due to chronic paranasal sinusitis was admitted to our hospital because of recently aggravated nasal stuffiness, headache, and cough. The X-ray film of paranasal sinuses and facial CT scan showed marked mucosal thickening of the nasal cavity and paranasal sinuses. The plain chest film and chest CT scan showed multiple, variable sized, pulmonary nodules in both lungs. The level of c-ANCA was elevated and urinalysis revealed proteinuria and hematuria. Percutaneous lung and kidney biopsies were performed for confirmative diagnosis. Histologic examination of the lung nodule demonstrated extensive necrosis and poorly-formed granulomatous inflammation. The histologic finding of the kidney showed focal necrotizing glomerulonephritis. A diagnosis of Wegener's granulomatosis involving the paranasal sinuses, lung and kidney was made, and treatment was successfully performed with cyclophosphamide and prednisone.
Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Cough ; Cyclophosphamide ; Diagnosis ; Glomerulonephritis ; Headache ; Hematuria* ; Humans ; Inflammation ; Kidney ; Lung ; Middle Aged ; Multiple Pulmonary Nodules* ; Nasal Cavity ; Necrosis ; Paranasal Sinuses ; Prednisone ; Proteinuria* ; Sinusitis* ; Thorax ; Tomography, X-Ray Computed ; Urinalysis ; Wegener Granulomatosis ; X-Ray Film