BACKGROUND:Acute vestibular neuronitis is the disease of which the etiology and pathophysiology are largely unknown . But the viral infection and ischemia of the labyrinth and the vestibular nerve are considered as general etiology. This study was performed to support the viral infection rather than the ischemic theory. MATERIALS & METHODS:We studied seventy years old female patient who showed painful vesicles on left auricle and vertigo with spontaneous nystagmus to the right side. We performed physical examination, serologic test, ENG test, pure tone audiogram, brain magnetic resonance imaging and polymerase chain reaction. RESULTS:We found small vesicles and vascular injection in left EAC, herpes zoster IgG positive, spontaneous right beating in electronystagmograpy, 54% left canal paresis in Caloric test , decreasing left side Tc in velocity step rotatory test, decresed gain, deviation to left in symmetry and phase lead in sinusoidal harmonic acceleration test, normal range hearing in pure tone audiogram, microangiopathy on cortex in brain MRI and negative PCR. CONCLUSION:This case supports viral infection etiology rather than ischemia in vestibular neuritis. But more studies to find the etiology of vestibular neuronitis are required.
Acceleration ; Brain ; Caloric Tests ; Ear, Inner ; Female ; Hearing ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Immunoglobulin G ; Ischemia ; Magnetic Resonance Imaging ; Paresis ; Physical Examination ; Polymerase Chain Reaction ; Reference Values ; Serologic Tests ; Vertigo ; Vestibular Nerve ; Vestibular Neuronitis

The gross tissue specimens are a valuable aid to the teaching of pathology and anatomy. However, traditional methods for storage and handling of them are discouragingly difficult and, recently, minimal surgical resections as well as preoperative interventions make it more difficult to have instructive gross specimens. Plastination is a process of tissue preservation by impregnation with silicone polymers or epoxy resins. The process in our study involves dehydration by cryosubstitution in aceton, defatting, forced impregnation of silicon polymer in a vacuum, curing and finishing. We submitted 40 surgically resected specimens to plastination. The resulting specimens are odorless, relatively dry, durable, life-like, non-hazardous, maintenance-free, and do not deteriorate with time. Plastinated specimens are a useful adjunct to the teaching of pathology, particularly suited for use in small groups, and appropriate method of tissue preservation. They are much preferred to wet preparation and conventional pots by both students and teachers owing to their accessibility, superior illustrative powers, and comparative ease of interpretation.
Dehydration ; Epoxy Resins ; Humans ; Pathology* ; Polymers ; Silicones ; Tissue Preservation ; Vacuum

The extracorporeal respiratory support has (ECMO) or extracorporeal lung assist (ECLA). Jugulocarotid(JC) ECLA, which drains venous blood via the internal jugular vein and perfuses via the common carotid artery, is recognized as a therapeutic modality for acute respiratory failure of neonates. But recent follow-up studies report the possible neurologic complications after the ligation of the carotid artery. Femoro-femoral (FF) bypass is reported to be effective in cardiac support during cardiopulmonary resuscitation. Surgical approach of FF bypass is easier because of the superficial location of great vessels. To evaluate the cardiorespiratory support of FF bypass, twelve mongrel dogs were divided into JC and FF groups(n6 in each group) and ventilated artificially at F1O2 of 0.3 and 0.15 in a dog. While ventilating the oxygenator with N2 gas, control hemodynamic and blood gas values were obtained at FO1O2 0.3 and at F1O2 0.15. The values during VA ECLA in both groups were measured while flushing O2 gas into the oxygenator. We compared bypass flows and oxygenation effects between two groups. l) The comparison between JC ECLA and FF ECLA in F1O2 0.3 Mean arterial pressure (MAP) and cardiac output (CO) increased in both groups and mean pulmonary arterial pressure (MPAP) decreased in JC group. Bypass flow rates were 86+/-6ml/kg/min in JC group and 62+/-8 ml/kg/min in FF group. 2) The comparison between JC ECLA and FF ECLA in FO 0.15 MAP and CO increased in both groups and MPAP decreased in JC group. VA ECLA increased the arterial oxygen tension from 49+/-12 mmHg to 93+/-20 mmHg in JC group and from 54+/-14 mmHg to 77+/-12 mmHg in FF group. Bypass flow rates were 103+/-21 ml/kg/min in JC group and 67+/-12 ml/kg/min in FF group. The amount of changes of deltaPaO2(y) related to bypass ratio(x) was same between two groups The systemic oxygenation effect of FF ECLA in hypoxia was as efficient as that of JC ECLA. In conclusion, FF ECLA can be adopted for acute respiratory failure in which PaO2 is maintained about 50mmHg.
Animals ; Anoxia ; Arterial Pressure ; Cardiac Output ; Cardiopulmonary Resuscitation ; Carotid Arteries ; Carotid Artery, Common ; Dogs* ; Flushing ; Hemodynamics ; Humans ; Infant, Newborn ; Jugular Veins ; Ligation ; Lung* ; Oxygen* ; Oxygenators ; Respiratory Insufficiency

BACKGROUND: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupunture, herbal medicine, faith, spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physicians' attitude and behavior towards alternative medicine. METHODS: Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice. RESULTS: 150 questionnaires were returned and among them 139 completed ones (18.1%) were analyzed. Among 770 doctors, 35 (25.2%) have referred patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractice in the order of seguence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors (10.8% ) had some experience in practicing an alternative approach and the patient subjeccts were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupunture, herbs in the order of seguence. CONCLUSIONS: Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.
Canada ; Chiropractic ; Chronic Pain ; Complementary Therapies* ; Female ; Herbal Medicine ; History, Modern 1601- ; Humans ; Musculoskeletal Diseases ; Primary Health Care ; Referral and Consultation ; Seoul* ; Surveys and Questionnaires

OBJECTIVE: Although several prior works showed the white matter (WM) integrity changes in amnestic mild cognitive impairment (aMCI) and Alzheimer's disease, it is still unclear the diagnostic accuracy of the WM integrity measurements using diffusion tensor imaging (DTI) in discriminating aMCI from normal controls. The aim of this study is to explore diagnostic validity of whole brain automated probabilistic tractography in discriminating aMCI from normal controls. METHODS: One hundred-two subjects (50 aMCI and 52 normal controls) were included and underwent DTI scans. Whole brain WM tracts were reconstructed with automated probabilistic tractography. Fractional anisotropy (FA) and mean diffusivity (MD) values of the memory related WM tracts were measured and compared between the aMCI and the normal control groups. In addition, the diagnostic validities of these WM tracts were evaluated. RESULTS: Decreased FA and increased MD values of memory related WM tracts were observed in the aMCI group compared with the control group. Among FA and MD value of each tract, the FA value of left cingulum angular bundle showed the highest area under the curve (AUC) of 0.85 with a sensitivity of 88.2%, a specificity of 76.9% in differentiating MCI patients from control subjects. Furthermore, the combination FA values of WM integrity measures of memory related WM tracts showed AUC value of 0.98, a sensitivity of 96%, a specificity of 94.2%. CONCLUSION: Our results with good diagnostic validity of WM integrity measurements suggest DTI might be promising neuroimaging tool for early detection of aMCI and AD patients.
Alzheimer Disease ; Anisotropy ; Area Under Curve ; Brain ; Diffusion Tensor Imaging ; Humans ; Memory ; Mild Cognitive Impairment* ; Neuroimaging ; Sensitivity and Specificity ; White Matter

PURPOSE: inhaled nitric oxide(iNO) is an excellent method for the postoperative pulmonary hypertension in congenital heart disease. But more detailed care is needed because of the development of rebound pulmonary hypertension after NO Withdrawal. We performed this study in order to discontinue the iNO successfully by way of presenting the adequate weaning and supplying methods. METHODS: Between January, 1998 and August, 1999 we sudied 10 patients who had rebound pulmonary hypertension(RPH) after iNO withdrawal. We completed the iNO in these patween the first the second trial of the weaning process. We tried to discover the differences between the first and second weaning process. We measured NO concentration at the start and just before NO withdrawal and during the period of weaning process. Moreover, to identify the iNO effects during the weaning of the iNO, we counted the degree of the change of PaO2/FiO2and mean PAP/SAP beween initial and at half of the initial NO concentration. RESULTS: Second weaning had a longer duration weaning process(11+/-0 cersus 5+/- hours, P<0.05), lower NO concentration just before NO withdrawal(2+/-.6 versus 4+/-ppm, P<0.05). In the change of the mean PAP/SAP and PaO2/FiO2as iNO was weaning from the initial iNO concentration to a half of the initial iNO concentration, the degree of increase in mean PAP/SAP(0.026+/-.07 versus 0.054+/-.07, P<0.05) and the degree of decrease in PaO2/FiO2(49+/-4 versus 65+/-2, P<0.05) were smaller in the second in the second weaning process than the first weaning process. CONCLUSION: A successful weaning of iNO can be performed with a low iNO concentration at the start and just before withdrawal and with the long duration iNO weaning process. Moreover, We speculate that the degree of change in the mean PAP/SAP and PaO2/FiO2at the half of the iNO weaning process are an indicator for the development of RPH.
Heart Defects, Congenital ; Humans ; Hypertension, Pulmonary ; Nitric Oxide* ; Weaning*

BACKGROUND: An increasing number of cases of target-controlled infusion (TCI) of propofol have substituted 2% propofol for 1% due to the concerns about lipid deposition and the practical convenience. However, 2% propofol may possess a higher proportion of free aqueous propofol because of the relatively decreased lipid-solvent ratio as compared to that for 1% propofol. We performed a prospective, randomized, double-blind trial to evaluate the pain of 1% and 2% propofol TCI. The efficacy of lidocaine pretreatment to abolish the pain was also tested for each concentration of propofol. METHODS: Two hundred adult patients were randomly allocated to 4 groups according to the pretreatment drugs and propofol concentrations; placebo (normal saline) and 1% propofol group (group 1), placebo and 2% propofol group (group 2), lidocaine and 1% propofol group (group 1L), and lidocaine and 2% propofol group (group 2L). Administration of pretreatment drug was followed by TCI with using each concentration of propofol. Pain was assessed using a four-point scale during propofol infusion. RESULTS: Propofol pain was more frequent (82% vs. 63%, respectively, P = 0.026), and severe (P = 0.002) for the group 2 than for group 1. Pain was significantly reduced by lidocaine pretreatment in the group 2L (48%) and group 1L (19%), as compared with group 2 (82%) and group 1 (63%), respectively (P < 0.001, both). However, group 2L still showed considerable pain that was similar to the pain of group 1. CONCLUSIONS: TCI of 2% propofol caused more frequent and severe pain despite of lidocaine pretreatment.
Adult ; Anesthesia ; Humans ; Lidocaine ; Propofol ; Prospective Studies

Dysgerminoma developed in a 21-year-old phenotypic female patient with 46,XY pure gonadal dysgenesis, Swyer syndrome. This patient presented with pelvic mass associated with abdominal pain and primay amenorrhea. Clinical characteristics showed a typical stigmata of gonadal dysgenesis: primary amenorrhea, sexual infantilism, a small uterus and left streak gonad. A 46,XY karyotype was made by lymphocyte culture. The patient was counseled to undergo operation, chemotherapy and hormon therapy. She underwent bilateral gonadectomy with total hysterectomy, partial omentectomy and multiple pelvic wall random biopsy. Histological examination revealed dysgenetic gonads with dysgerminoma. After surgery, the patient received chemotherapy and also was started on hormone replacement therapy. She is currently alive with no evidence of disease after 19 months from surgery.
Abdominal Pain ; Amenorrhea ; Biopsy ; Christianity ; Drug Therapy ; Dysgerminoma* ; Female ; Gonadal Dysgenesis ; Gonadal Dysgenesis, 46,XY* ; Gonads ; Hormone Replacement Therapy ; Humans ; Hysterectomy ; Karyotype ; Lymphocytes ; Sexual Infantilism ; Uterus ; Young Adult

The aortic coarctation is located in the distal thoracic aorta or abdominal aorta, or both and is often called "middle aortic syndrome" or "mid-aortic dyspastic syndrome". Etiology is controversial and most cases are seen in young female women. Severe complication such as cardiac or renal dysfunction as well as cerebral hemorrhage may occur, so aggressive surgical intervention may take effect. Lately we experienced a middle aortic syndrome which was not typical because of the patient's advanced age at the time of clinical presentation. The Axillo-femoral artery bypass graft with 6 mm PTFE vascular graft was done.
Aorta, Abdominal ; Aorta, Thoracic ; Aortic Coarctation ; Arteries ; Cerebral Hemorrhage ; Female ; Humans ; Middle Aged* ; Polytetrafluoroethylene ; Transplants ; Vascular Diseases

The authors developed a computerized electroencephalography imaging system with an IBM PC AT. The EEG signals amplified with a 16 channel EEG machine were digitized at 51.2 Hz (512 samples per epoch). The shifted DC potential and 60Hz artificats were removed by a high pass filter and 60Hz notch filter. A window function consisting of a 10% cosine taper was obtained by weighting the points at either end of the epoch by a cosine bell. A fast Fourier transform was applied to every epoch and the power spectrum estimates were computed in 0.39 Hz steps. The activity estimates for the delta, theta, alpha and beta bands were computed by summimg adjacent values. The outline of the top-down maps was formed from a series of sagittal cuts, then 32 electrodes were placed on the map. A file was created which contained a table of weighting parameters for calculating the interpolated values for every point within the outline. Each weight was in inverse linear proportion to the distance of the pixel to the nearest four electrodes. The map was finally generated with computation of the spectral EEG in each pixel according to the weighting parameter. The functioning of this system was tested with a functional generator and a human subject.
Brain Mapping/methods ; *Diagnosis, Computer-Assisted ; Diagnostic Imaging ; *Electroencephalography ; Human ; *Microcomputers ; Support, Non-U.S. Gov't