No abstract available.
Epithelium* ; Humans* ; Insulin*

No abstract available.
Gait* ; Humans ; Spinal Cord Diseases*

A 67-year-old man, with a history of pontine hemorrhage, was admitted because of ocular tremors. Also, tremors in the right upper limb and palates were detected. Oculopalatine tremors showed synchronous vertical oscillations and the limb showed midbrain tremor. Brain MRI revealed high signal intensities of both inferior olivary nuclei and right superior cerebellar peduncle. Electromyogram showed different tremor frequencies in the oculopalate and limb. Clinical, MRI and electromyographic findings indicate that the origins of oculopalatine and limb tremors are different.
Aged ; Brain ; Extremities ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Mesencephalon* ; Palate ; Tremor* ; Upper Extremity*

Primary lymphoma of uterine cervix is rare disease, which usually occurs in postmenopausal periods. The usual symptoms are vaginal bleeding, postcoital bleeding. The most common pathologic feature is a diffuse cell type, B-cell line. Pap smear is not helpful in diagnosis because it is stromal origin. Biopsy confirms the diagnosis. Treatment consists of radiation therapy and/or chemotherapy. The prognosis of the disease is dependent upon Ann arbor stage and International index score rather than FIGO stage. We experienced one case of primary lymphoma of cervix and report it with a brief review of literature.
B-Lymphocytes ; Biopsy ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Female ; Hemorrhage ; Lymphoma* ; Postmenopause ; Prognosis ; Rare Diseases ; Uterine Hemorrhage

BACKGROUND: Coronary artery bypass graft (CABG) surgery is performed more frequently than before in Korea. Central nervous system (CNS) complications are often the major prognostic determinants following the surgery. We carried out a prospective study to clarify the incidence and risk factors of neurologic complications after CABG surgery. METHODS: A consecutive series of 150 patients undergoing 152 CABG operations from March 1995 to July 1997 by one cardiac surgeon was evaluated by a team of neurologists before and after the surgery. The patients received extensive preoperative examinations including the evaluation of intracranial & extracranial cerebral artery disease. RESULTS: In 44 operations (28.9%), we detected various neurologic complications, including encephalopathy (36 operations, 23.7%), cerebral infarction (5 operations, 3.3%), and seizure (7 operations, 4.6%). Eight patients died postoperatively including one due to neurologic complication. On univariate analysis, age, degree of intracranial artery disease (ICAD), duration of bypass time, hypotension index, duration of ventricular assistant device (VAD), intraoperative event, intra- or postoperative arrhythmia, reoperation, and postoperative bleeding were statistically significant risk factors of CNS complications (p< 0.05). After multivariate analysis, however, age alone remained significant (p=0.02). The degree of ICAD showed marginal significance (p=0.06). CONCLUSIONS: The incidence of CNS complication in the patients undergoing CABG surgery was 28.9%. Our results showed that age was an independent risk factor of CNS complications. And the possibility of ICAD as a risk factor was suggested. Further study with a large number of patients would be necessary to prove the above suggestion.
Arrhythmias, Cardiac ; Arteries ; Central Nervous System* ; Cerebral Arterial Diseases ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Korea ; Multivariate Analysis ; Prospective Studies ; Reoperation ; Risk Factors ; Seizures ; Transplants

PURPOSE: Although advancement in treatment and diagnostic tools related to hepatocelluar carcinoma has been much improved, long term survival rates of hepatocellular carcinoma are still low because of delayed clinical manifestations and underlying diseases causing the cancer. Various kinds of modalities to treat hepatocellular carcinoma have developed but surgical resection is still recognized as the best method. Therefore, we studied the associated factors of long-term survival after liver resection. METHODS: We retrospectively analyzed 184 patients who were pathologically diagnosed with hepatocellular carcinoma from May 1990 to December 2002. Associated factors of long-term survival classified as preoperative, operative, pathological and recurrence factors. Univariate and multivariate analyses were done using cross tabulation analysis and logistic regression analysis. RESULTS: The cumulative 1-, 3- and 5- year survival rates were 66%, 50% and 30%, respectively. Preoperative factors, significantly associated with long-term survival, were age of 60 years and under, tumor size, HBe Ag status and preoperative tumor marker level. As pathological factors, the vascular invasion and lymphatic invasion status were significantly associated. But cirrhosis of the liver was not associated with long-term survival. And in cases of recurrence, patients who had undergone repeat resection survived significantly longer. CONCLUSION: The most significant factors of multivariate analyses were lymphatic invasion status. Tumor size, ICG-R15 and HBe Ag status followed second. We should correct the preoperative factors through screening and early diagnosis. And when recurrence occurs, if the recurring cancer has resectability, repeat hepatectomy will increase the patient's lifespan.
Carcinoma, Hepatocellular ; Early Diagnosis ; Fibrosis ; Hepatectomy ; Humans ; Liver ; Logistic Models ; Mass Screening ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Rate

OBJECTIVE: The incidence of spinal metastases continues to increase, likely a result of increasing survival times for patients with cancer. This retrospective study was undertaken to analyze the results of surgery and the outcome of patients with extradural metastases in the cervical spine. METHODS: Thirty-three patients with cervical spine metastases who underwent spinal surgery by two surgeon at a single center in a 14-year period(1993-2007) were analyzed. Indications for surgery include intractable pain, neurological deficits, spinal cord compression, and the need for stabilization of impending pathological fractures. Numerous factors affect outcome including the nature of the primary cancer, the presence of fracture or dislocation, approach of surgery, and the severity of spinal cord compression. The change of predominant symptoms and survival time were evaluated after surgery. RESULTS: There were 17 male and 16 female patients aged from 29 to 78 years old(mean age, 59.9 years). Among the metastatic tumors, colon, breast, and liver were the most common primary sites of origin, and lung, kidney, stomach and thyroid were also common. All patients had bony invasion and 24 patients had pathologic vertebral fracture and 6 patients had dislocation. Based on the tumor location, approaches included 12 anterior, 6 posterior and 15 combined. Epidural spinal cord compression on the axial T2-weighted magnetic resonance(MR) image was noted in 31 patients(93.9%). The American Spinal Injury Association(ASIA) impairment scale scores in preoperative state were stable in 29 patients(87.9%) who presented with ASIA Score D and E. The most common predominant symptoms of patients were cervical and/or radiating pain(26 patients) and 23 patients had neurological deficits. At Follow-up, predominant preoperative symptoms improved in 28(84.8%) patients who had pain or neurological deficits. The overall mean survival duration for patients with cervical metastatic tumors after diagnosis was 7.4 months in 28 expired patients and 17.4 months in 5 survived patients. There were four major early and late complications in this study. One patient suffered from the immediate postoperative epidural hematoma and improved after evacuation of hematoma. There were three cases of instrumentation failure. One of them was symptomatic and underwent second-look surgery. CONCLUSION: Surgery for the treatment of cervical spine metastases is effective for improvement of the neurological deficits and relief the local pain in a significant proportion of patients with acceptable complication rates. The tech- nical evolution of cervical implants has improved our ability to achieve long-term rigid fixation, particularly over the cervicothoracic junction.
Aged ; Asia ; Breast ; Cervical Vertebrae ; Colon ; Dislocations ; Female ; Follow-Up Studies ; Fractures, Spontaneous ; Hematoma ; Humans ; Incidence ; Kidney ; Liver ; Lung ; Magnetics ; Magnets ; Male ; Neoplasm Metastasis ; Pain, Intractable ; Retrospective Studies ; Spinal Cord Compression ; Spinal Injuries ; Spine ; Stomach ; Thyroid Gland

PURPOSE: We developed an objective structured oral examination (OSOE) case to assess the medical ethics of students. The aim of this study was to assess the reliability of OSOE with generalizability theory. METHODS: One 10-minute OSOE that contained key questions was developed. The evaluation sheet consisted of 4 domains: moral sensitivity, moral reasoning, decision making, and attitude. The total number of items was 13. The numbers of checklist items and global rating items were 11 and 2, respectively. Items and key questions were validated by 6 professionals. Standardization of the raters and the pilot study was performed before the OSOE. Fifty-four third-year medical students participated in the OSOE. The OSOE was duplicated, and 2 professors assessed 1 student independently. Each station lasted 8 minutes and was followed by a 2-minute interval,during which raters completed the checklist forms. We analyzed the reliability of the OSOE with the GENOVA program. RESULTS: The reliability (generalizability coefficient) was 0.945, and the interrater agreement was 0.867. The type of item, checklist or global rating, was the largest variance component. The reliability of the checklist alone was 0.668 and that of the global rating alone was 0.363. CONCLUSION: The OSOE is reliable and can be used to assess ethics. More research should focus on achieving validity.
Checklist ; Clinical Competence ; Decision Making ; Diagnosis, Oral ; Educational Measurement ; Ethics, Medical ; Humans ; Mental Competency ; Pilot Projects ; Statistics as Topic ; Students, Medical

PURPOSE: To evaluate the efficacy of monocular slanted lateral rectus (LR) muscle recession for exotropia with convergence insufficiency. METHODS: Twenty five patients with exotropia greater at near than at versus far distance by > or =10 prism diopters (PD), were divided into two groups: 15 patients who underwent monocular slanted LR recession (study group), and 10 patients who underwent monocular standard LR recession (control group). In the study group, the lower horn of the LR was recessed according to near deviation, the upper horn was recessed according to distance deviation. In the control group, monocular LR was recessed according to distance deviation. The postoperative ocular alignment at distance and near, and the difference between them, were measured and compared retrospectively. The criteria for successful outcome were postoperative residual deviation at near and distance, and the difference of 8 PD or less between the two. RESULTS: The mean distance deviation showed a significant postoperative reduction in both groups (P<0.001, P<0.001). The mean near deviation showed a significant postoperative reduction in both groups (P<0.001, P<0.001). The mean difference between near and distance deviation showed a significant postoperative reduction only in the study group (P<0.001, P=0.175). Successful outcome was obtained in 13 our of 15 (86.7%) patients in the study group, in 2 out of 10 (20%) patients in the control group. None of the study patients had postoperative diplopia. CONCLUSIONS: Monocular slanted lateral rectus recession is effective in reducing both distant and near exodeviation and in collapsing the difference between distance and near deviation them at postoperative 4 months.
Animals ; Diplopia ; Exotropia* ; Horns ; Humans ; Ocular Motility Disorders* ; Retrospective Studies

Purpose: Implant-based breast reconstruction is the most common reconstruction method used after mastectomy in breast cancer patients. Many studies have compared the smooth round implants and textured anatomical implants. This study aimed to compare the complications, including capsular contracture, between these two implants used in direct-toimplant (DTI) breast reconstruction. Methods: This retrospective chart review was performed using a prospectively maintained database from a single center. We identified patients who underwent mastectomy with DTI single-stage breast reconstruction at our hospital between August 2011 and June 2021. The overall complications, including capsular contracture, postoperative infection, seroma, hematoma, implant rupture, implant exposure, rippling, implant malposition, and nipple necrosis, were analyzed. Results: In total, 340 breasts of 323 patients were reconstructed by the DTI approach using either textured anatomical (n = 203) or smooth round (n = 137) implants. The incidence of overall complications and capsular contracture was significantly lower with smooth round implants than with textured anatomical implants. Multivariate analysis showed that smooth round implants were associated with a reduced risk of overall complications (odds ratio [OR], 0.465; 95% confidence interval [CI], 0.265–0.813) and capsular contracture (OR, 0.475; 95% CI, 0.235–0.962). Particularly, smooth round implants were associated with a decreased risk of overall complications in patients not receiving adjuvant chemotherapy and a decreased risk of capsular contracture in patients with body mass index < 25 kg/m2 and in those not receiving adjuvant radiotherapy. Conclusion Smooth round implants demonstrated a decreased risk of overall complications and capsular contracture when compared with textured anatomical implants. These results may be utilized in counseling patients regarding the advantages and disadvantages of smooth round implants in DTI breast reconstruction.