OBJECTIVE: We analyzed the main causes leading to a poor outcome (severe disability, a vegetative state and death) following surgical treatment for ruptured intracerbral aneurysms. METHODS: Between January 1994 and December 2007, we maintained a retrospective database of 339 patients who underwent surgical clipping. The various causes we investigated were the technical problems during operation, the initial SAH or ICH, vasospasm, hydrocephalus and the post-operative medical complications. The clinical outcome was assessed according to the Glasgow Coma Scale (GOS). RESULTS: There were 263 cases of good outcomes (77.6%) and 76 cases of poor outcomes (22.4%). The three main causes of a poor outcome were 1) preoperative causes such as the direct insult of the initial SAH and ICH in 21 cases (27.6%), 2) intra-operative causes such as the technical problems during dissection and clipping of the aneurysm neck in 29 cases (38.2%) and 3) postoperative causes such as clinical vasospasm in 16 cases (21.1%). The mean follow-up period was 17.6 months (range : 2 months to 9 years). CONCLUSION: A meticulous neck dissection and complete obliteration of the aneurysm preserving parent arteries and perforators are the most effective and prime methods that surgeons can employ to reduce the rate of poor outcomes when performing ruptured aneurysm surgery.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Microsurgery ; Neck ; Neck Dissection ; Parents ; Persistent Vegetative State ; Retrospective Studies ; Surgical Instruments

There is growing evidence of the association between inflammation and stress-related disorders including depression. The positive correlation between the increased levels of inflammatory cytokines observed in patients with other diseases and the byproduct of the depressive symptoms may be caused by chronic stress. Increased neuroinflammatory responses are capable of activating microglia and astrocytes, which leads to release pro-inflammatory cytokines. Moreover, elevated levels of inflammatory cytokines such as tumor necrosis factor-alpha, interleukin (IL)-1, and IL-6 are causally related to various aspects of depression such as the behavioral symptomatology. Eventually, these elevated cytokines aggravate and propagate neuroinflammation, impairing brain functions. Thus, activated astrocytes and microglia may be potential mediators in neuroinflammatory processes contributing to the development of depression.

OBJECTIVE: The safety and effectiveness of Guglielmi Detachable Coil(GDC) embolization for cerebral aneurysm has been well documented. However, domestically there are few reports. The purpose of this study is to analyze procedural complications that occurred during endovascular coilling performed for cerebral aneurysms retrospectively. METHODS: From January 1996 to December 2003, a total of 453 patients (484 aneurysms) who had undergone GDC embolization for cerebral aneurysm were selected. The aneurysms were classified according to rupture history, location, dome and neck size. Procedural complications such as aneurysmal rupture, thrombosis and occlusion of patent vessels due to coil escape were noted. RESULTS: Procedural complications occurred 49 cases (10.1%). Among these, there were 27 of procedure-related aneurysmal rupture (5.6%), 14 of thrombosis (2.9%), 8 of occlusion of patent vessels due to coil escape (1.7%). Death or severe neurological deficit were seen in 18 cases of procedure-related rupture, 9 cases of thrombosis and 4 cases of coil escape. Procedure-related mortality and morbidity rates for endovascular coiling were calculated to be 2.9% and 3.6% respectively. CONCLUSION: The potential complications associated with shape, size and relationship to parent vessels of each specific cerebral aneurysm must be considered carefully before treatment. In order to reduce complications, proper equipment, knowledge on the hemodynamics and vascular anatomy, and operator's expertise are desired.
Aneurysm* ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Mortality ; Neck ; Parents ; Retrospective Studies ; Rupture ; Thrombosis ; United Nations

Tracheal stenosis is a difficult disease entity to manage. Laser ablation is one effective treatment for treacheal stenosis and can be utilized if tracheal reconstructive surgery is impossible. Potassium titanyl phosphate laser, transmitted via flexible quartz fiber, can be precisely manipulated through flexible bronchoscope under local anesthesia. We treated 7 patients with tracheal and broncheal lesion under local anesthesia with KTP laser from January 1995 to July 1996. The patients included three males and four females. The age of patients ranged from 22 to 66 years with a mean of 43.7 years. The etiology of tracheal stenosis in patients was stenosis after tracheostomy(3 cases), prolong inturbation in cases of sepsis(1 cases), and the recurrence of lung cancer within endobronchial lesion(2 cases). In the cases of tracheal stenosis treated with laser ablation, there were 2 cases of recurrence of stenosis at the anastomosis site after the operation, 3 cases of stenosis at tracheostomy site, and 2 cases of local recurrence of lung cancer. The site of the tracheal stenosis was the balloon site of the tracheostomy tube(3-4cm inferior to the tracheostomy site, 2-3cm superior to the carina) and the anastomosis site that were narrowed to less than 5mm(4 cases). For the stenosis lesion in the endobronchial area, there were 2 patients with a lesion at the anterior wall, 1 patient with a lesion at the posterior wall, 2 patients with circumferential stenosis. Laser ablation time was 25.4+/-5.9min and used energy was 1768+/-365J. We have used KTP laser via flexible bronchoscope without major complications. Adjuvant radiation therapy may prevent fibroblast proliferation which leads to restenosis. In three patients of restenosis after laser ablation, adjuvant irradiation started within 4 hours after laser ablation, and the radiation doses were 1500cGy given in five fraction. In patients with adjuvant radiation therapy, stenosis has not recurred.
Anesthesia, Local ; Bronchoscopes ; Constriction, Pathologic ; Female ; Fibroblasts ; Humans ; Laser Therapy ; Lasers, Solid-State ; Lung Neoplasms ; Male ; Potassium* ; Quartz ; Radiotherapy, Adjuvant ; Recurrence ; Tracheal Stenosis* ; Tracheostomy

Three strains, YP416 T , YP421 T, and Y422, were isolated from soil samples in Pocheon City, Gyeonggi province, South Korea. The strains belong to two novel yeast species in the genus Mrakia. Molecular phylogenetic analysis showed that the strain YP416 T was closely related to Mrakia niccombsii. Still, it differed by 9 nucleotide substitutions with no gap (1.51%) in the D1/D2 domain of the LSU rRNA gene and 14 nucleotide substitutions with 7 gaps (2.36%) in the ITS region. The strain YP421 T differed from the type strain of the most closely related species, Mrakia aquatica, by 5 nucleotide substitutions with no gap (0.81%) in the D1/D2 domain of the LSU rRNA gene and 9 nucleotide substitutions with one gap (1.43%) in the ITS region. The names Mrakia terrae sp. nov. and Mrakia soli sp. nov. are proposed, with type strains YP416 T (KCTC 27886 T ) and YP421 T (KCTC 27890 T ), respectively. MycoBank numbers of the strains YP416 T and YP421 T are MB 836844 and MB 836847, respectively.

The coexpression of cortical and medullary features in a single adrenal cortical cell has been recognized, leading to terms such as cortico-medullary cells. Here, we reported a case of adrenocortical adenoma consisting of cortico-medullary cells that clinically mimicked pheochromocytoma. A 52-year-old woman was admitted to our hospital complaining of an 8-month history of paroxysmal palpitation with refractory hypertension. A 24-hour urine study revealed increased norepinephrine and metanephrine levels. Computed tomography of the abdomen revealed a 1.0x0.9-cm mass in the left adrenal gland. The patient subsequently underwent unilateral laparoscopic adrenalectomy for a presumptive pheochromocytoma. Light microscopic findings of the left adrenal mass indicated an adrenocortical adenoma, but electron microscopy identified lipid vacuoles and smooth endoplasmic reticulum, along with dense core neurosecretory granules, so-called cortico-medullary cells. This is the first report of the detection of cortico-medullary cells in adrenocortical adenoma presenting as pheochromocytoma in Korea.
Abdomen ; Adrenal Glands ; Adrenalectomy ; Adrenocortical Adenoma ; Endoplasmic Reticulum, Smooth ; Female ; Humans ; Hypertension ; Light ; Metanephrine ; Microscopy, Electron ; Middle Aged ; Norepinephrine ; Pheochromocytoma ; Vacuoles

Neutropenic enterocolitis is an acute life-threatening, necrotizing inflammation of cecum and terminal ileum often seen in leukemia and lymphoma during periods of prolonged or severe neutropenia. It has been also referred to as necrotizing enterocolitis, ileocecal syndrome, or typhlitis (from the Greek word typhlon meaning cecum). The pathophysiology of the neutropenic enterocolitis is unknown but is believed to be multifactorial. The clinical symptoms of neutropenic enterocolitis are nonspecific including fever, abdominal pain (often right lower quadrant), abdominal distension, diarrhea, bloody stools, nausea, and vomiting. So acute appendicitis is should be included in the differential diagnosis. The early signs and symptoms are nonspecific and it may rapidly lead to intestinal perforation. The definite management of neutropenic enterocolitis is contrversial. but the prognosis is likely to be good with early diagnosis and proper management. We report one case of neutropenic enterocolitis in acute myelogenous leukemia with literature review.
Abdominal Pain ; Appendicitis ; Cecum ; Diagnosis, Differential ; Diarrhea ; Early Diagnosis ; Enterocolitis, Necrotizing ; Enterocolitis, Neutropenic* ; Fever ; Ileum ; Inflammation ; Intestinal Perforation ; Leukemia ; Leukemia, Myeloid, Acute* ; Lymphoma ; Nausea ; Neutropenia ; Prognosis ; Typhlitis ; Vomiting

PURPOSE: This study was conducted to evaluate the correlations among pulmonary contusion severity, trauma score and cardiac troponin I (cTnI) level. METHODS: We prospectively evaluated patients with multiple injuries who had been admitted to the emergency department (ED) from July 2007 to July 2008. We first measured the total creatinine kinase (CK), the MB fraction of CK (CK-MB), TnI, and myoglobin within 2 hours after the injury. We then checked the electrocardiogram, x-ray, and computed tomography (CT) results. Finally, we assessed the injuries as variables and then compared the results for patients with elevated TnI levels (group A) and patients whose TnI levels fell within the normal range (group B). RESULTS: Eighty-six of the 92 patients admitted to the ED were enrolled. The pulmonary contusion score (PCS) was well correlated with PaO2/FiO2. TnI levels were correlated with PCS. When TnI levels were above 0.86 ng/ml, the mortality was estimated with 100% sensitivity and 86.1% specificity. CONCLUSION: Pulmonary contusion severity is correlated with TnI level. When the PCS is high and the cTnI level is elevated in multiple-injury patients, we recommend continuous cardiac monitoring and further evaluation.
Contusions ; Creatinine ; Electrocardiography ; Emergencies ; Humans ; Injury Severity Score ; Multiple Trauma ; Myoglobin ; Phosphotransferases ; Prospective Studies ; Reference Values ; Troponin I

PURPOSE: In most areas of the world, transfers between emergency centers are performed through direct communication between physicians of transferring and receiving hospitals. The emergency medical information center "1339" (or 1339, for short), which had mediated inter-hospital transfers for about 10 years, was recently discontinued. This study aimed to survey the stance of physicians at transferring and receiving hospitals on the importance of 1339 functions. METHODS: In May 2012, before the discontinuation of 1339 as a mediator, a questionnaire was distributed to emergency-related physicians at several hospitals on the level of emergency care in Busan. RESULTS: There were 202 answers. Physicians of high level emergency centers had a higher tendency to transfer patients without pre-contact for transfer (p=0.019). The physicians at each level of care thought that direct communication between physicians was more accurate (69.9%), but mediation through 1339 was more convenient (53.6%). Mediation through 1339 was the most frequent resource used for pre-contact of inter-hospital transfers (58.1%). CONCLUSION: Physicians at each level of care tended to find pre-contact between physicians more accurate for inter-hospital transfers; however, they also thought mediation through 1339 was more convenient and it was the most frequently used resource for pre-contact of inter-hospital transfers.
Community Networks ; Emergencies ; Emergency Medical Services ; Hospital Information Systems ; Humans ; Information Centers ; Negotiating ; Surveys and Questionnaires

BACKGROUND: Effective cardiopulmonary resuscitation (CPR) should provide acceptable hemodynamics for the vital organs during cardiac arrest and early restoration of spontaneous circulation that guarantees long-term, neurologically intact survival. CPR using heart-lung bypass has been suggested as an option for that use. This study was designed to determine the effectiveness of standard CPR techniques, closed-vs. open-chest CPR, which could be used in the future study verifying the role of heart-lung bypass CPR. MATERIAL AND METHOD: By using adult mongrel dogs, closed-chest CPR (CCCPR, n=4) and open-chest CPR (OCCPR, n=5) were compared with respects to hemodynamics, restoration of spontaneous circulation (ROSC), and survival. Ventricular fibrillation-cardiac arrest (VF-CA) was induced by electrical shock in all animals. After 4 minutes of cardiac arrest, basic life support (BLS) was applied for 15 minutes and followed by advanced life support (ALS). ALS was maintained until achi ving ROSC but not longer than 30 minutes regardless of the recovery. Resuscitation procedures in either group were standardized by adopting the protocol of American Heart Association. RESULT: Prearrest baseline hemodynamic data was not different between two groups. During resuscitation, substantially higher systolic pressure was maintained in OCCPR group than in CCCPR group (45+/-15 vs. 33+/-11 mmHg during BLS, 83+/-36 vs. 44+/-15 mmHg during ALS; p=NS). Mean pulmonary arterial pressure went up to the level of mean systemic arterial pressures in CCCPR group and to half of that in OCCPR group, and had kept higher in CCCPR group throughout CPR (32+/-10 vs. 22+/-4 mmHg during BLS and 32+/-15 vs. 24+/-10 mmHg during ALS; p=NS). ROSC was obtained in 4 of 5 dogs receiving open-chest CPR and 2 of 4 closed-chest CPR. Prolonged survival was noted in all dogs in OCCPR group (6 to 1440 hours) but not in CCPR group (p<.05). CONCLUSION: These findings indicate that open-chest CPR can be more effective t maintain hemodynamics during cardiac arrest and to obtain restoration of spontaneous circulation and survival. Further experiment will be designed to compare heart-lung bypass CPR with open-chest CPR.
Adult ; American Heart Association ; Animals ; Arterial Pressure ; Blood Pressure ; Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation ; Dogs ; Heart Arrest ; Hemodynamics ; Humans ; Resuscitation ; Shock ; Ventricular Fibrillation