OBJECTIVE: Spontaneous intracranial hypotension(SIH) is a rare condition presented with cardinal postural headache and low CSF pressure. The authors describe the characteristic clinical features, imaging findings, and treatment methods in the patients with spontaneous intracranial hypotension. METHODS: Between May 1994 and Aug. 2001, eight patients were diagnosed with spontaneous intracranial hypotension based on characteristic radiologic and clinical findings in our department. All cases were shown diffuse meningeal enhancement(DME) on magnetic resonance(MR) image. Two cases had subdural hematoma. RESULTS: The most characteristic feature on Brain MR image is DME with/without subdural fluid collection. Radionuclide image reveals direct leaking point and rapid appearance of urinary bladder activity. Direct leaking points were detected in all four cases who performed radioisotope study. Autologous epidural blood patches were applied to four cases, and all of them were improved without complication. Among four patients treated with conservative method, three were improved, but one patient was died of spontaneous chronic subdural hematoma. CONCLUSION: We suggest that 1) meticulous studies need to be performed aggressively if SIH is diagnosed clinically and radiologically, 2) the most effective study may be radioisotope study, and 3) if leaking point is found, aggressive management such as autologous epidural blood patches is recommended.
Blood Patch, Epidural ; Brain ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Chronic ; Humans ; Intracranial Hypotension* ; Urinary Bladder

Imatinib-mesylate (Gleevec, Glivec) is a protein-tyrosine kinase inhibitor that inhibits the Bcr-Abl tyrosine kinase created by the Philadelphia chromosome abnormality in CML. Imatinib is also used to treat patients with c-kit (CD 117)-positive unresectable tumors, or metastatic malignant gastrointestinal stromal tumors, or both. Imatinib is a well- tolerated drug with few side effects. However, it has been associated with gastrointestinal irritation, fluid retention and edema, skin rashes, depigmentation, hepatotoxicity, hemorrhage, and hematological toxicity (anemia, neutropenia, and thrombocytopenia). In addition, imatinib has been associated with dyspnea and cough, which are mainly secondary to the pleural effusion and pulmonary edema, which represent local or general fluid retention. These events appear to be dose related and are more common encountered in the elderly. However, there has been no report of hypersensitivity pneumonitis associated with imatinib-mesylate in Korea. We report a case of 51-year old woman who developed hypersensitivity pneumonitis that might have been induced by imatinib-mesylate during the treatment of a gastrointestinal stromal tumor.
Aged ; Alveolitis, Extrinsic Allergic* ; Cough ; Dyspnea ; Edema ; Exanthema ; Female ; Fusion Proteins, bcr-abl ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Hypersensitivity* ; Korea ; Middle Aged ; Neutropenia ; Philadelphia Chromosome ; Pleural Effusion ; Protein-Tyrosine Kinases ; Pulmonary Edema ; Imatinib Mesylate

BACKGROUND: It has been known that radial artery pressure (RAP) some times underestimate the central pressure. In many studies, femoral artery pressure (FAP) and RAP have been considered as central and peripheral artery pressures, respectively and there might be a possibility that age and the change of blood pressure exert different effect on FAP and RAP. This study evaluated the effect of esmolol (E) on RAP and FAP and the changes in their pulse pressure (PP) in different age groups. METHODS: Fifty-one adult patients without cardiovascular disease were enrolled in this study. Twenty six patients were younger than 25 years (group 1) and 25 patients were older than 50 years (group 2). Radial and femoral arteries were cannulated and recorded before anesthesia. After induction of anesthesia, FAP, RAP and heart rate were recorded (T1) and then E was infused to decrease the FAP to 15% lower than its value of T1(T2). Variables were recorded 30 sec after the cessation of E infusion. RESULTS: Systolic pressure and PP of RAP were greater than of FAP in group 1, but those of FAP were greater than of RAP in group 2 before anesthesia. FAP was higher than RAP in both groups after anesthesia, regardless of the infusion of E. E infusion didn't change the pressure gradients between FAP and RAP in either group, except systolic pressure gradient in group 2. The PP of FAP was identical with of RAP in group 1 at both T1 and T2 but greater than of RAP in group 2 at both periods. E decreased the PP of both RAP and FAP in both groups. CONCLUSIONS: RAP is lower than FAP, and the PP of both pressures are affected by age and esmolol after anesthesia. However, the differences between both pressures are maintained after E infusion.
Adult ; Anesthesia ; Arteries ; Blood Pressure* ; Cardiovascular Diseases* ; Femoral Artery ; Heart Rate ; Humans ; Phenylephrine ; Radial Artery*

Carbon monoxide (CO) is a well-known chemical asphyxiant, which causes tissue hypoxia with prominent neurological injury. Therapeutic hypothermia (TH) has been shown to be an effective neuroprotective method in post-cardiac arrest patients. A 26-year-old man presented to the emergency department with severe CO poisoning. On arrival, the patient was comatose. His vital signs were blood pressure, 130/80 mm Hg; heart rate, 126/min; respiratory rate, 26/min; body temperature, 36degrees C; and O2 saturation, 94%. Initial carboxyhemoglobin was 45.2%. Because there was no available hyperbaric chamber in our local area, he was intubated and treated with TH. The target temperature was 33 +/- 1degrees C for 24 hours using an external cooling device. The patient was then allowed to reach normothermia by 0.15-0.25degrees C/hr. The patient was discharged after normal neurological exams on day 11 at the hospital. TH initiated after exposure to CO may be an effective prophylactic method for preventing neurological sequelae.
Anoxia ; Blood Pressure ; Body Temperature ; Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Carboxyhemoglobin ; Coma ; Emergencies ; Heart Rate ; Humans ; Hypothermia ; Hypothermia, Induced ; Respiratory Rate ; Vital Signs

PURPOSE: We wanted to evaluate the clinical results and the radiological and arthroscopic findings of femoroacetabular impingement (FAI) in young Taekwondo players and to investigate the rate of returning-to-play Taekwondo and the recurrence rate. MATERIALS AND METHODS: Twenty Taekwondo players (16 males and, 4 females) who were arthroscopically treated for FAI from September 2003 to July 2008 were retrospectively analyzed. Their mean age was 21.6 years old (range: 17 to 32 years) and the mean follow up was 33.7 months (range: 24 to 71 months). Plain radiographs and 3 dimensional computed tomography were taken in all patients and magnetic resonance arthrography was performed in 11 with suspicious soft tissue lesions. Labral injury, cartilage injury and associated lesions were evaluated by arthroscopy. The preoperative and postoperative visual analogue scale (VAS), the modified Harris hip score (MHHS), the sports frequency score (SFS), and the non-arthritic hip score (NAHS) were compared. We investigated the rate of returning-to-play at postoperative 1 year and at postoperative 2 years and the recurrence rate within 2 years after surgery. RESULTS: There were 10 cam types, 1 pincer type and 9 mixed types. The mean alpha angle improved from 65.8 degrees preoperatively to 43.2 degrees postoperatively (p<0.001). Acetabular labral tears were accompanied in all cases and the most common tear site and type were at 2 o'clock and degenerative tear, respectively. In descending order, the acetabular cartilage injuries were located in the anterosuperior, posteroinferior and anterior portion, respectively. The femoral cartilage injuries were mostly located in the anterosuperior portion. The range of motion at the final follow-up showed improvement in all except abduction (p=0.262). The VAS, MHHS and SFS showed statistically significant improvement (p<0.001). The NAHS was improved, but without statistical significance (p=0.31). The rates of returning-to-play at postoperative 1 year and postoperative 2 years were 85% (17/20) and 75% (15/20), respectively. The recurrence rate within postoperative 2 years was 15% (3/20). CONCLUSION: As screening test for FAI in young Taekwondo players is necessary at the beginning of Taekwondo. Arthroscopic treatment in symptomatic Taekwondo players is an effective procedure that can improve the postoperative exercise frequency and function. Returning-to-play Taekwondo is associated with the clinical improvements and the patients' will.
Arthrography ; Arthroscopy ; Cartilage ; Femoracetabular Impingement ; Follow-Up Studies ; Hip ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Mass Screening ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Sports ; Sulfides

PURPOSE: To conduct a nationwide survery on the principles in radiotherapy for rectal cancer, and develop the framework of a database of Korean Patterns of Care Study. MATERIALS AND METHODS: A consensus committee was established to develop a tool for measuring the patterns in radiotherapy protocols for rectal cancer. The panel was composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area. The committee developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer. The survey items developed for measuring the treatment principles were composed of 1) 8 eligibility criteria, 2) 20 items for staging work-ups and prognostic factors, 3) 7 items for principles of combined surgery and chemotherapy, 4) 9 patient set-ups, 5) 19 determining radiation fields, 6) 5 radiotherapy treatment plans, 7) 4 physical/laboratory examination to monitor a patient's condition during treatment, and 8) 10 follow-up evaluations. These items were sent to radiation oncologists in charge of gastrointestinal malignancies in all hospitals (48 hospitals) in Korea to which 30 replies were received (63%). RESULTS: Most of the survey items were replied to without no major differences between the repliers, but with the following items only 50% of repliers were in agreement:1) indications of preoperative radiation, 2) use of endorectal ultrasound, CT scan, and bone scan for staging work-ups, 3) principles of combining chemotherapy with radiotherapy, 4) use of contrast material for small bowel delineation during simulation, 5) determination of field margins, and 6) use of CEA and colonoscopy for follow-up evaluations. CONCLUSION: The items where considerable disagreement was shown among the radiation oncologists seemed to make no serious difference in the treatment outcome, but a practical and reasonable consensus should be reached by the committee, with logical processes of agreement. These items can be used for a basic database for the Patterns of Care Study, which will survey the practical radiotherapy patterns for rectal cancer in Korea.
Colonoscopy ; Consensus ; Drug Therapy ; Follow-Up Studies ; Humans ; Korea ; Logic ; Radiotherapy ; Rectal Neoplasms* ; Seoul ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonography

PURPOSE: Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic central pancreatectomy (LCP) with open central pancreatectomy (OCP). The aim of this study was to compare clinical outcomes between LCP and OCP as a single institutional study. METHODS: During the study period (From January, 1998 to December, 2010), we performed central pancreatectomy in 95 cases. Among them, 26 cases of totally LCP and 55 cases of OCP were compared retrospectively. RESULTS: Benign pancreatic neoplasm was the main indication. The mean operation time for the LCP group (350.2 min) was longer than that for the OCP group (283.4 min). And there was no significant difference in mean actual blood loss (477 ml versus 714 ml, p=0.083) between the LCP and OCP groups. Return to a normal bowel movement and resumption of a liquid diet were achieved 5.5+/-2.6 days after the operation in the LCP group and 6.6+/-2.0 days after the operation in the OCP group (p=0.039). The mean duration of postoperative hospital stay was 13.8 days for the LCP group, which was significantly shorter than the 22.5 days for the OCP group (p=0.015). The overall complication rate was 42.3% (11 cases) in the LCP group and 45.5% (25 cases) in the OCP group (p=0.790). CONCLUSION: Use of LCP for benign or low grade malignant lesions of the pancreatic neck portion is feasible and safe. Compared to the open method, the laparoscopic approach to central pancreatectomy appears to provide advantages of early resumption of a normal diet and reduction of postoperative hospital stay without further complications.
Diet ; Laparoscopy ; Length of Stay ; Neck ; Pancreatectomy ; Pancreatic Fistula ; Pancreatic Neoplasms