BACKGROUND: The Wada test is an essential part of the preoperative evaluations in candidates for epilepsy surgery. Impaired reactions (IR) to intracarotid sodium amytal infusions include: confusion, disorientation, and decreased respon-siveness, thereby confounding test results. We retrospectively analyzed the factors affecting the impaired reactions (IR) regarding both individual and methodologic factors. METHODS: Subjects included 202 patients (age;28.5+/-9.48, range:8 to 64 years, M:F=113:89) with intractable epilepsy. Patients with IR (IR group) and those without IR (Non-IR group) were compared with respect to individual factors such as: age, sex, epilepsy syndromes, injected hemispheres, dominan-cy as well as methodologic factors including amobarbital doses. With regards to the dose of amobarbital, the total accu-mulated dose as well as the initial injected dose, were used. RESULTS: IR was observed in 50 patients (24.7%). Compared to the non-IR group, the IR group had more prolonged, contralateral weakness and total test times, but the same duration of EEG changes. IR occurred more frequently with injections into the left hemisphere (p<0.001), the dominant hemi-sphere (p<0.0001), and contralateral hemisphere of epileptic focus (p<0.07). The IR group received significantly higher amounts of amobarbital than the non-IR group (p<0.05). Considering the oversedation as well as the undersedation of amobarbital together, 100mg of amobarbital was the most appropriate dose in the Wada test. CONCLUSIONS: These results suggest that dominant hemisphere injections and usage of higher doses of amobarbital can frequently produce IR in the Wada test. The ideal dose of amobarbital in the Wada test for Korean patients should be 100mg.
Amobarbital ; Electroencephalography ; Epilepsy ; Humans ; Retrospective Studies

We report our case of laparoscopy-assisted distal gastrectomy with D1 + beta lymph node dissection for a patient with early gastric cancer and laparoscopic cholecystectomy for gallstone with situs inversus totalis. A superficial elevated lesion was found on the lesser curvature of the antrum. The preoperative diagnosis was cStage IA (cT1, cN0, cH0, cP0, cM0). A 1 cm-sized gallstone was found in the fundus through upper abdominal ultrasound. A laparoscopy-assisted distal gastrectomy with standard D2 lymph node dissection for early gastric cancer and laparoscopic cholecystectomy was successfully performed by not shifting the monitor to the left and right and not changing operator's position without additional blood loss and time. The number of retrieved lymph nodes was 36. We have not found any abnormal course of blood vessels except for the right/left inversion. Billroth I reconstruction was performed through end-to-side anastomosis. Based on a histopathological examination, a 1.5 x 1.5 cm, submucosal (sm3), moderately differentiated adenocarcinoma (pT1, pN0, sH0, sP0, sM0, stage IA) was diagnosed. The postoperative course was favorable and the patient was discharged on postoperative day 7.
Adenocarcinoma ; Blood Vessels ; Cholecystectomy, Laparoscopic ; Gallstones ; Gastrectomy ; Gastroenterostomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Organothiophosphorus Compounds ; Situs Inversus ; Stomach Neoplasms

No abstract available.
Pregnancy* ; Substance-Related Disorders*

DNA flow cytometric analysis was performed on paraffin-embedded tissue from 10 cases of squamous cell eareinoma (SCC) and 10 cases of basal cell carcinoma(BCC). These results were applicable to do a better prognosis in BCC than SCC. In 10 cases of SCC, the DNA index was 1.34 and aneuploidy was identified in 9. In 10 cases of BCC, the DNA index was 1.30 and aneuploidy was identified in 6.
Aneuploidy ; Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell* ; DNA* ; Flow Cytometry* ; Prognosis ; Skin*

No abstract available.
Choledochal Cyst* ; Cholestasis*

Epilepsy is one of the most common episodic neurological diseases characterized by recurrent epileptic seizures. The seizures occur by synchronization of a neuronal network, which may cause disturbances in intracellular ion homeostasis, neuronal excitability, network remodeling, and neuronal death. The neuronal death following epileptic seizures results from the execution of cellular programs that are similar to those in developmentally programmed cell death. Research into cell death after seizures has identified the molecular machinery of apoptosis including the caspases and bcl-2 family proteins. The author reviews the clinical experimental evidences of programmed death pathway function in epileptic seizures. Four neuronal death pathways after epileptic seizures are proposed; non-programmed necrotic, programmed necrotic, programmed apoptotic extrinsic, and programmed apoptotic intrinsic pathways. Epileptogenesis is speculated based on the programmed pathways. Research on seizure-induced neuronal damage has developed considerably in recent years and that may open new ways to improve neuroprotective and antiepileptic treatments for patients with epilepsy.
Apoptosis ; Caspases ; Cell Death* ; Epilepsy* ; Homeostasis ; Humans ; Neurons ; Seizures

Large cell neuroendocrine carcinoma (LCNEC) of the lung is a newly recognized entity of pulmonary neuroendocrine carcinoma. Histologically, it is very difficult to differentiate LCNEC from other pulmonary carcinomas and the prognosis is significantly poor. The cutaneous metastasis of LCNEC of the lung shares some features with Merkel cell carcinoma of the skin in light microscopy and yet it is negatively stained with cytokeratin 20. We report a case of cutaneous metastasis of LCNEC of the lung, previously misdiagnosed as squamous cell carcinoma. Our patient showed a poor response to the chemotherapy and also revealed a brain metastasis on follow-up brain CT scan.
Brain ; Carcinoma, Merkel Cell* ; Carcinoma, Neuroendocrine* ; Carcinoma, Squamous Cell ; Drug Therapy ; Follow-Up Studies ; Humans ; Keratin-20 ; Lung* ; Microscopy ; Neoplasm Metastasis ; Prognosis ; Skin ; Tomography, X-Ray Computed

OBJECTIVE: To know the clinical features of overuse injury in performing musicians and to evaluate related factors that may affect the overuse injury and playing related pain. METHODS: Eighty professional musicians and music college students were examined during 1 year. All were examined by a history taking, physical examination, radiologic exam and if needed electromyography. Nonparametric Sperman's correlation were used for the statistic analysis and 5 interval grading system, visual analog scale for pain, and stress, criteria of joint hypermobility were used for various measurements. RESULTS: Fifty four men were studied in 3 music colleges and a professional orchestra. Frequency of symptom was 46.3%. The string players were most frequently affected (65%), whereas the wind instrument players were least frequently affected (11.5%). The most commonly affected site was the hand and wrist (54.2%) followed by the spine. Patients were divided by the severity into 5 groups and among them the grade 1 was most common (29.6%). No significant correlation was seen between the practice hours per week but a significant correlation was noted between the stress and playing related pain. Joint hypermobility plays an important role in music playing which is dependent on the kind of instruments. CONCLUSION: Incidence of the overuse injury in musicians is high in Korea and the prevention and early treatment are essential for the good outcome of overuse syndrome.
Cumulative Trauma Disorders* ; Electromyography ; Hand ; Humans ; Incidence ; Joint Instability ; Korea ; Male ; Music ; Physical Examination ; Spine ; Visual Analog Scale ; Wind ; Wrist

BACKGROUND: In recent studies, tacrolimus ointment has been shown to be effective for the treatment of atopic dermatitis with an excellent safety profile. OBJECTIVE: This study was done to assess the efficacy and side-effects of tacrolimus ointment for the facial atopic dermatitis(AD) in Korean. PATIENTS AND METHODS: Open-label, non-comparative study with 2 months' follow-up was done to assess the efficacy and safety of tacrolimus ointment (Protopic0ointment 0.1%, Fujisawa, Japan) in moderate to severe facial AD. Patients were instructed to apply it two times daily for 8 weeks. Facial lesions were evaluated at baseline, 4 and 8 weeks of treatment with in-tensity score by investigator. RESULTS: In comparing of intensity scores and each clinical score at baseline with those of 4 and 8 weeks of treatment, a significant decrease was noticed at all follow-up periods. Burning sense(54.5%) and pruritus(18.2%) were detected. CONCLUSION: Tacrolimus ointment is effective in treatment of severe facial AD and has tolerable mild adverse effects at the site of application in Korean.
Burns ; Dermatitis, Atopic* ; Follow-Up Studies ; Humans ; Research Personnel ; Tacrolimus*

We experienced a case of venous hemangioma occuring on the inner aspect of right forearm of 40-year-old woman. The skin lesion was slight tender, pea sized, dark brown surfaced, subcutaneous mass. The entire dermis was filled with numerous coiled thick walled vessels surrounded by fibrous stroma on the histopathologic examination. The wall, lined by a single layer of endothelial cells, lacked elastic fibers on the specimen of Verhoeff-Van Gieson and Massons trichrotne stains.
Adult ; Coloring Agents ; Dermis ; Elastic Tissue ; Endothelial Cells ; Female ; Forearm ; Hemangioma* ; Humans ; Peas ; Skin