The authors report a case of thoracic outlet syndrome in left side. Thoracic outlet syndrome is a collective term in which symptoms and signs are due to bony and soft tissue compression of the neurovascular bundle at the thoracic outlet. It is a rare case in neurosurgical field. So we had experienced one case of thoracic outlet syndrome which was improved by transaxillary approach for resection of first rib. The clinical features, diagnostic test, radiological findings, and operative technique are presented with review of literatures.
Brachial Plexus ; Diagnostic Tests, Routine ; Ribs* ; Thoracic Outlet Syndrome*

No abstract available.
Amyloidosis*

There are some emergency situations when untested fresh blood should be transfused. Emergency blood donor tests(EBDT) have been done as an effort to protect these blood recipients from contracting transfusion associated infections in Seoul National University, Hospital. EBDT includes HBsAg, anti-HlV, STS, and ALT test. Anti-HCV test is not included because of the absence of appropriate test kit. A total of 534 tests have been done from June 1993 to August 1995. Among these, 495 tests(92.7%) have been done for blood donor screening, and 39 tests(7.3%) for emergency organ transplantation. Sensitivity and specificiy of the emergency HBsAg test were 69% and 98%, respectively. There were two RPR reactive blood donors, but no anti-HIV positive cases. Among 458 blood donors, 37 donors(8.1%) showed increased ALT level(> 45IU/L). The percent of agreement in HBsAg, elevated ALT and anti-HIV tests between emergent and routine blood donor tests, were 97.0%, 98.9% and 100%, respectively. Although false positive and false negative EBDT result may is useful, although limited, we think that EBDT is useful in protecting blood recipient from transfusion associated infections.
Blood Donors* ; Emergencies* ; Hepatitis B Surface Antigens ; Humans ; Mass Screening ; Organ Transplantation ; Seoul ; Transplants

Thirty three patients with mild to moderate essential hypertension were administered ramipril, a new ACe inhibitor, 2.5-5mg once daily for 6 weeks to evaluate the hypotensive efficacy and safety. The results were as follows : 1) The patients consisted of 18 males, 15 females, aged 54 on average and classified as mild in 19 and moderate in 14 patients. 2) At the end of 6 weeks trial, blood pressure dropped 13/6mmHg on average, rewarding 70% effectiveness and normalized below 150/90mmHg in 39%. 3) The most frequent side reaction was dry cough in 5 patients(15%) followed by asthenia, GI trouble, dizziness, edema, eye injection and one case of GPT elevation which normalized after completion of trial. 4) The rating of safety of safety was 79% and of overall usefulness was 73%. In conclusion, ramipril 5mg once daily regimen is well tolerated and effective in the treatment of mild to moderated essential hypertension.
Asthenia ; Blood Pressure ; Cough ; Dizziness ; Edema ; Female ; Humans ; Hypertension* ; Male ; Ramipril* ; Reward

Pulmonary embolism is the impaction of material into branches of the pulmonary arterial bed. It usually occurs in patients with primary hypercoagulable states or secondary hypercoagulable states like cancer, preganancy, and estrogen replacement therapy. We report a case of a pulmonary embolism in a patient with positive lupus anticoagulant who received estrogen replacement therapy. The patient was referred due to suddenly developed shortness of breath and echogenic mass densities in the right atrium on 2 dimensional echocardiography. The patient was markedly improved with intravenous urokinase and subsequent oral anticoagulant therapy. Related articles are also reviewed.
Dyspnea ; Echocardiography ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Heart Atria ; Humans ; Lupus Coagulation Inhibitor* ; Pulmonary Embolism* ; Urokinase-Type Plasminogen Activator

PURPOSE: Many investigators suggested that changes in hormonal environment in the postmenopausal women functionally or histologically effect the clitoris and vagina. We investigated the mechanism of female se xual dysfunction occurring in the decreased hormonal status, and aimed to establish and experimental base for the hormone replacement in postmenopausal women to correct sexual dysfunction. MATERIALS AND METHODS: Twenty mature female New Zealand white rabbits were randomly divided into three groups; control group, oophorectomy group, estrogen replacement group after oophorectomy. Nitric oxide synthase (NOS) activity and the degree of expression of neuronal NOS (nNOS) and endothelial NOS (eNOS), collagen content in clitoral tissues were analysed. RESULTS: nNOS and eNOS were significantly increased in the oohporectomized group while decreased in the estrogen replacement group (p<0.01). NOS activity showed the similar pattern of change (p<0.05). Oophorectomy induced a significant increase in collagen content, while the ratio of smooth muscle content was increased significantly after the estrogen replacement (p<0.01). CONCLUSIONS: Estrogen deficiency induces collagen synthesis and decreases the content of smooth muscle in clitoris, resulting in a structural relaxation difficulty. We believe that NOS becomes more active to improve the relaxation difficulty and that hormone replacement helps to restore the normal state of smooth muscle relaxation. Considering these findings, we suggest that estrogen down-regulates NOS and its activity.
Clitoris* ; Collagen ; Estrogen Replacement Therapy ; Estrogens* ; Female ; Humans ; Muscle, Smooth ; Neurons ; Nitric Oxide Synthase ; Ovariectomy ; Rabbits ; Relaxation ; Research Personnel ; Vagina

BACKGROUND: In spite of the development of diagnostic tools, gallbladder carcinoma is often diagnosed at a late stage because of the lack of symptomatic awareness of patients in early stage. Early diagnosis and proper resectional treatment is, therefore, the most important factor for the prognosis. This study aims at the analysis of clinical characteristics and the effect of various modes of surgical treatment on long-term survival. METHODS: From January 1989 to December 1997 we operated on 132 patients with gallbladder carcinoma. Age, sex, stage distribution, clinical manifestations and mode of operations were analyzed. The cumulative survival rates were also analyzed for 107 patients who had been finally followed up, and the significance of survival difference was tested (p<0.05). RESULTS: The average age of 132 patients was 64 years old, and female patients suffered more frequent incidence than male patients by a ratio of 1.7:1. The distribution of patients according to the pathologic TNM staging showed early stage (stage 0 & I) accounted for only 9.8% whereas the advanced stages (stage II, III, IVa, IVb) accounted for the majority of the patients (90.2%). The chief complaints were abdominal pain (84.8%), indigestion, weight loss, palpable mass and so forth in a decreasing frequency order. Among the patients, 30 cases (22.7%) were irresectable, 50 cases (38%) were curative resected, and 52 cases (39%) were palliative resected. The overall cumulative survival rates of 107 patients were 53.7%, 41.7% and 30.1% for 1-year, 2-year and 5-year survival respectively. Although the 5-year survival rate of curative resected patients showed a significantly better survival rate (p<0.005) than that of non-curative resected patients, the different modes of combined radical surgery did not affect the survival rates. CONCLUSION: Combined curative resection ameliorated long-term survival of patients with gallbladder carcinoma. For the further evaluation of the efficacy of combined radical surgery on survival, more extensive data needs to be accumulated.
Abdominal Pain ; Dyspepsia ; Early Diagnosis ; Female ; Gallbladder* ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Survival Rate ; Weight Loss

Echinococcal cyst is a rare disease in Korea. A 33 year old man who had lower abdominal discomfort for 4 months, and multiple cysts in intraperitoneal and retroperitoneal cavity on abdominal CT. scan. On abdominal exploration, the multiple were diagnosed for Echinococcal cyst. Thin case is the first documented case of multiple Echinococcal cysts among Koreans reported in the literature.
Adult ; Humans ; Korea ; Rare Diseases ; Tomography, X-Ray Computed

BACKGROUND: Although therapeutic plasmapheresis (TP) is a useful procedure in removing pathogenic antibodies and toxic substances from the patient, adverse reactions could arise from the use of replacement fluids and anticoagulants. Comprehensive analysis on those adverse effects had been rarely reported in Korea. METHODS: We retrospectively investigated the clinical records and the TP records from 3,962 TP sessions for 581 patients between January 1995 and October 2008 at Asan Medical Center, and we analyzed the adverse reactions related to TP. RESULTS: Adverse reactions were seen in 142 patients (24.4%) in 348 TP procedures (8.8%). Citrate toxicity was most frequently seen in 83 procedures (23.9%) followed by chills in 72 procedures (20.7%), allergic reactions in 69 procedures (19.8%) and hypotension in 60 procedures (17.2%). Citrate toxicity, chills and allergic reactions were seen more frequently in the TP procedures using FFP than in the TP procedures using albumin (P=0.001). The prevalence of citrate toxicity was significantly lower in the cases where calcium gluconate was administered (P<0.001), while it was significantly higher in the patients whose hematocrit was below 28.5% (P<0.001). In terms of severity, the mild, moderate and severe adverse reactions were 36.8%, 56.3% and 6.9%, respectively. CONCLUSION: TP is a relatively safe method of treatment, but it is important to predict and prevent adverse reactions and to respond appropriately to these adverse reactions.
Antibodies ; Anticoagulants ; Calcium Gluconate ; Chills ; Citric Acid ; Gluconates ; Hematocrit ; Humans ; Hypersensitivity ; Hypotension ; Plasmapheresis ; Prevalence ; Retrospective Studies

The purpose of this study were to investigate the changes in serum SGOT, CK and CK-MB levels and the significance of these changes during general anesthesia for open heart surgery. Fourteen patients, who had open heart surgery at Kyungpook National University hospital, were chosen at random their serum SGOT, CK and CK-MB levels were recorded before anesthesia(control group), pre cardiopulmonary bypass, during cardiopulmonary bypass and in the recovery room. The results were as follows: The serum SGOT levels were 21.83+/-4.91 IU/L, 27.20+/-11.83, 34.81+/-16.60 and 72.58+/-37.77, respectively. They very significantly increased (p<0.01) during cardiopulmonary bypass and recovery room compared with pre anesthesia. The serum CK levels were 58.07+/-6.31 IU/L, 91.79+/-44.58, 141.93+/-66.55 and 347.43+/-84.61 respectively. They significantly increased (p<0.05) at pre cardiopulmonary bypass, very significantly increased(p<0.01) during cardiopulmonary hypass and recovery room compared with the preanesthesia. The serum CK-MB levels were 0.00 U/L, 4.54+/-11.80, 14.66+/-17.61 and 80.07+/-34.72 respectively. They very significantly increased(p<0.01) during the cariopulmonary bypass and recovery room.
Anesthesia* ; Anesthesia, General ; Aspartate Aminotransferases* ; Cardiopulmonary Bypass ; Gyeongsangbuk-do ; Heart* ; Humans ; Recovery Room ; Thoracic Surgery*