The presnt study was carried out to find out any difference in terms of the rate of rebleeding, mortality and of the occurrence of vasopasm and hydrocephalus between the two groups of patients with subarachnoid hemorrhage : a group of 225 cases which were administered with epsilon aminocaproic acid(EACA) (antifibrinolytic agent) and the other a group of 221 cases without EACA treatment. Both groups were chosen from 476 patients admitted to the Department of Neurosurgery, Kyung-Hee University Medical Center within 7 days after the onset of subarachnoid hemorrhage during a period from January 1982 to December 1987. The clinical observation was done during acute period following subarachnoid hemorrhage. The major findings obtained were as follows : 1) The occurrence of rebleeding was higher within 3 days after the onset of subarachnoid hemorrhage. The rate of rebleeding was 8.4% in treated group whereas the rate was 13.1% in control group. This may suggest that administration of EACA is effective to prevent rebleeding. 2) the occurrence of vasopasm was higher within on the 7th and 8th day after the onset of subarachnoid hemorrhage. The rate of vasospasm was 28.9% in treated group whereas the rate was 12.4% in control group. This means that the rate of occurrence of vasospasm was two times higer in EACA treated group. 3) the rate of occurrence of hydrocephalus was 18.3% in treated group whereas the rate lower in control group(11.6%). 4) Within-two-weeks mortality and within-one-month mortality were 14.7% and 22.2% respectively in treated group whereas the two rates in control group were 15.1% and 24.1% respectively. No significant difference between the two groups was observed. 5) The causes of death in treated group were found to be vasospasm(55.5%) and rebleeding(28.0%) in order, whereas in control group the causes of deaths were rebleeding(40.2%) and vasospasm(21.3%). In other words, the main cause of death was vasospasm in treated and that in control group was rebleeding.
Academic Medical Centers ; Cause of Death ; Humans ; Hydrocephalus ; Mortality ; Neurosurgery ; Subarachnoid Hemorrhage*

PURPOSE: Condyloma acuminatum is a common lesion of the external genitalia and anus. However, its involvement of the urethra is uncommonly, but when it does the lesions are difficult to eradicate. Treatments have included excision, electrical fulguration and laser therapy. Laser therapy causes minimal damage to the urethral mucosa, and stricture formation seems less likely when use. The results of intraurethral condyloma acuminatum, treated with Nd:YAG laser therapy, are reported. MATERIALS AND METHODS: Between June, 2000 and May, 2002, 13 men, with intraurethral condyloma, were treated by Nd:YAG laser therapy at our institution. All patients underwent cystourethroscopy to rule out concomitant urethral and vesicle disease. Biopsies of all lesions were performed, with the specimens sent for DNA viral typing. After removal of the condyloma, cystourethroscopy was used on follow-up at three-month intervals. RESULTS: All the patients were found to have condyloma acuminatum. Of these, 3 (23.1%) had concomitant distal urethral lesions and 7 (53.8%) had an associated cutaneous condyloma. All the patients were found to have type 6/11 human papillomavirus disease, as confirmed by their viral typing. A recurrence was observed in only 1 patient, and no complications were reported. CONCLUSIONS: For intraurethral condyloma acuminatum, Nd:YAG laser therapy is successful, and cystourethroscopy is required for the diagnosis and at follow-up.
Anal Canal ; Biopsy ; Condylomata Acuminata ; Constriction, Pathologic ; Diagnosis ; DNA ; Follow-Up Studies ; Genitalia ; Humans ; Laser Therapy* ; Male ; Mucous Membrane ; Neodymium ; Recurrence ; Urethra

Choriocarcinoma associated with a normal pregnancy is rare. Futhermore, choriocarcinoma coexistent with a viable pregnancy is even rarer and associated with a greater risk of hepatic and cerebral involvement. So timely diagnosis of the disease is important for successful treatment and aggressive diagnostic procedures may therefore warranted. The patient should be treated with primary intensive combination chemotherapy(EMA-CO) and the selective use of irradiation and surgical therapy. We experienced a case of metastatic choriocarcinoma of lung and kidney following preterm delivery at 34th week of pregnancy and so present it with brief review of literature.
Choriocarcinoma* ; Diagnosis ; Female ; Humans ; Kidney ; Lung ; Pregnancy ; Pregnancy*

No abstract available.

This study aims to investigate the factors related to the adoption of clinical practice guidelines in clinical settings in Korea; it also aims to determine how these factors differ depending on the specific situation of health care system and professional climate. The research sample comprised physicians who are board members of academic societies with experiences in development of clinical practice guidelines using a convenient sampling. We analyzed 324 physicians with pooling two-year sample of 2007 and 2008. From all the respondents, 48.8% stated that they followed Clinical Practice Guidelines, and 93.4% agreed with the content in the Clinical Practice Guidelines. With regard to the item on the self-efficacy of practicing guidelines, 90.3% of the respondents selected 'low level'. In the regression analysis, the factors associated with implementation were level of recognition, agreement and self-efficacy and positive attitude towards practice guidelines. Although the health care system in Korea differs from those in Western countries, our results revealed that the factors related to the adoption of practice guidelines were similar to the research results of Western countries. These results suggest that professionals' attitudes towards clinical practice guidelines are universal, and implementation strategies should be developed globally.
Adult ; Attitude of Health Personnel ; Awareness ; Female ; Guideline Adherence ; Humans ; Male ; Middle Aged ; *Models, Theoretical ; Physicians/psychology ; *Practice Guidelines as Topic ; Questionnaires ; Regression Analysis ; Republic of Korea ; Self Efficacy

With 4-Channel Nicolet-CA 1000 clinical averager, somatosensory evoked potentials(SSEP) and brainstem auditory evoked potentials(BAEP) were studied in 40 patients with intracerebral hematoma and 40 patients with cerebral infarction. SSEP was more sensitive response in putamen(20/23) or thalamic(6/7) hemorrhage and infarction of middle cerebral artery territory(13/28). in contrast BAEP was high percentage in abnormality in brainstem or cerebellar lesion. Cortical wave(N18) was usually not traceable in large size of hematoma or having midline shift in brain CT scan. There was close correlation between the severity of motor weakness and abnormality of SSEP. The best neurological outcome was found in the patients of P24 wave formation. In our results, SSEP and BAEP seemed to be very useful for evaluation of stroke patients.
Brain ; Brain Stem ; Cerebral Infarction ; Evoked Potentials* ; Hematoma ; Hemorrhage ; Humans ; Infarction ; Middle Cerebral Artery ; Stroke ; Tomography, X-Ray Computed

Tuberculous colitis, an important extra-pulmonary tuberculosis, is still prevalent in the developing countries and has been resurging in the Western world. The duration and dose of anti-tuberculous therapy have not yet been clarified in the tuberculous colitis. We experienced a case of tuberculous colitis, which relapsed after 9 months of therapy. A 28-year-old man presented with hematochezia and was diagnosed as tuberculous colitis on the basis of colonoscopic findings. He was treated with anti-tuberculous agents for 9 months successfully. Three months later, however, he complained of hematochezia again, suggesting the relapse of tuberculous colitis. He had taken anti-tuberculous therapy for another 15 months and showed no evidence of relapse. Although anti-tuberculous therapy is efficient for tuberculous colitis, rare cases of reactivation should be reminded.
Adult ; Colitis/*drug therapy/microbiology ; English Abstract ; Humans ; Male ; Recurrence ; Tuberculosis, Gastrointestinal/*drug therapy

BACKGROUND: Bioprostheses for cardiovascular surgery have limitations in their use following as calicification. alpha-galactosidase epitope is known as a stimulant of immune response and then shows a progressing calcification. The objective of this study was to evaluate histologic characteristics and mechanical properties of decellularization and treated with alpha-galactosidase. MATERIALS AND METHODS: Bovine pericardial tissues were allocated into three groups: fixation only with glutaraldehyde, decellularization with sodium dodesyl sulfate and decellularization plus treatment with alpha-galactosidase. We confirmed immunohistological characteristics and mechanical properties as fatigue test, permeability test, compliance test, tensile strength (strain) test and thermal stability test. RESULTS: Decellularization and elimination of alpha-gal were confirmed through immunohistologic findings. Decellularization had decreased mechanical properties compared to fixation only group in permeability (before fatigue test p=0.02, after fatigue test p=0.034), compliance (after fatigue test p=0.041), and tensile strength test (p=0.00). The group of decellularization plus treatment with alpha-galactosidase had less desirable mechanical properties than the group of decellularization in concerns of permeability (before fatigue test p=0.043) and strain test (p=0.001). CONCLUSION: Favorable decellularization and elimination of alpha-gal were obtained in this study through immunohistologic findings. However, those treatment including decellularization and elimination of alpha-gal implied the decreased mechanical properties in specific ways. We need more study to complete appropriate ioprosthesis with decellularization and elimination of alpha-gal including favorable mechanical properties too.
alpha-Galactosidase ; Bioprosthesis ; Compliance ; Fatigue ; Glutaral ; Pericardium ; Permeability ; Sodium ; Sprains and Strains ; Tensile Strength

Coronary artery fistula accounts for 0.27~0.4% of all congenital cardiac defects. In more than 50% of the cases, right coronary artery is involved. The fistula drains into the right heart in 92% of the cases. Left heart is the site of termination in only 8% of the cases, especially less left ventricle (3%). We experienced a case of right coronary artery to left ventricular fistula in a 3-year-old boy who was diagnosed incidentally and underwent ligation of fistula.
Child, Preschool ; Coronary Vessels* ; Fistula* ; Heart ; Heart Ventricles ; Humans ; Ligation ; Male

Doxifluridine neurotoxicity is more rare than 5-FU neurotoxicity. We report a case of leukoencephalopathy caused by long-term use of doxifluridine and which was resolved after discontinuation. A 37-year-old woman who had been on doxifluridine for 4 months after gastrectomy presented with dysarthria. Diffusion-weighted MRI imaging revealed multifocal hyperintense lesions in subcortical areas. Her symptoms disappeared after discontinuing doxifluridine, and lesions on follow-up MRI were resolved. These findings suggest that doxifluridine is a plausible cause of reversible leukoencephalopathy.
Adult ; Dysarthria ; Female ; Fluorouracil ; Follow-Up Studies ; Gastrectomy ; Humans ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Stomach Neoplasms*