BACKGROUND: Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. METHODS: We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3℃, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. RESULTS: Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024). CONCLUSIONS: AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.
Acalculous Cholecystitis ; Aneurysm* ; Aspartame ; Body Temperature ; C-Reactive Protein ; Cerebrovascular Disorders ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute* ; Critical Care ; Critical Illness ; Diabetes Mellitus ; Diagnosis ; Fasting ; Fever* ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Leukocyte Count ; Prognosis ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage* ; Urinary Bladder ; Vital Signs

No abstract available.
Epithelial Cells* ; Maxillary Sinus* ; Mucous Membrane*

A wide range of cognitive impairments and depression can be observed in most patients with Parkinson's disease (PD). But the underlying mechanism of these changes has not to be clarified yet. This study evaluated whether the frontal lobe dysfunctions contribute to the cognitive deficits in PD by comparison with age and education-matched controls. The neuropsychological tests known to be sensitive to frontal lobe dysfunction were performed to 38 patients with PD and matched 24 controls. These were composed of 'Category Fluency Test (CFT)' including objects, animals, & nations and 'Wisconsin Card Sorting Test (WCST)'. General cognition and depression were measured 'Korean Mini-Mental State Examination (K-MMSE)' and 'Beck Depression Inventory (BDI)' respectively. We examined the degree of motor disabilities in PD using the Hoehn-Yahr Stage. Patients with PD were assessed before noon and during the ""On"" time of levodopa to reduce the diurnal variation of mood and drug effects. Although PD patients, compared with controls, showed decreased ability in attention & calculation, memory, and visuo-spatial construction, the most prominent deficit was frontal lobe dysfunction evaluated with WCST and CFTs. Cognitive impairments in PD did not attribute to the discrepancy of education level or associated depression. So we suggest that the frontal lobe dysfunction may play an important role for cognitive impairments in PD.
Animals ; Cognition ; Depression ; Education ; Frontal Lobe* ; Humans ; Levodopa ; Memory ; Neuropsychological Tests ; Parkinson Disease*

PURPOSE: Recurrent abdominal pain syndrome (RAPS) is not uncommon in school-aged children, but the etiology and pathogenesis are not understood well. But recent studies suggest that motility disorder makes up a majority of the pathogenesis. The aim of this study was to investigate gastric emptying time (GET) which is a method to evaluate gastrointestinal motility in patients with recurrent abdominal pain syndrome. METHODS: Radionuclide GET was investigated in 34 patients who visited the Department of Pediatrics, Pusan National University Hospital due to recurrent abdominal pain from January 1996 to June 1997. After 8 hours of fasting, the patient received two pieces of toast and a fried egg tagged with 2 mci of 99mTc albumin colloid and sequential counting was accomplished. We calculated the geometric mean of two counts measured from AP-PA scans and investigated 60 minutes of intragastric radionuclide retention rate. RESULTS: A total of 34 patients (12 boys, 22 girls, M : F=1 : 1.8) participated in this study. The age ranged from 5 to 12 years and the mean age was 8.8 years. Associated symptoms were headache (7 patients), nausea (7 patients), constipation (2 patients), vomiting (1 patient), and diarrhea (1 patient). Anti-Helicobacter pylori IgG Ab was positive in 4 cases. Endoscopic gastritis was found in 6 cases. The mean of 60 minutes of intragastric radionuclide retention rate was 72 +/- 17% and 27 cases (79%) were delayed significantly. CONCLUSION: The results of our study suggest that delayed gastric emptying time is a cause of abdominal pain in patients with recurrent abdominal pain syndrome.
Abdominal Pain* ; Busan ; Child ; Colloids ; Constipation ; Diarrhea ; Fasting ; Female ; Gastric Emptying* ; Gastritis ; Gastrointestinal Motility ; Headache ; Humans ; Immunoglobulin G ; Nausea ; Ovum ; Pediatrics ; Vomiting

9p Tetrasomy is rare chromosomal aberration that was described in approximately 30 previous patients in the world and this is the first described in Korea. Here we report a 3 month-old boy who was referred for genetic evaluation because of facial dysmorphism, such as wide fontanells, hypertelorism, bulbous nose, low set ears, cleft lip and palate. He had also psychomotor retardation and hypotonia. He was diagnosed as tetrasomy 9p syndrome by clinical feature and chromosomal study. Thereafter, increased growing of head size compared with body weight and height was observed and brain MRI shows hydrocephaly associated with remarkable hypertrophy of choroid plexus and mild Dandy Walker syndrome.
Body Weight ; Brain ; Choroid Plexus* ; Choroid* ; Chromosome Aberrations ; Cleft Lip ; Dandy-Walker Syndrome ; Ear ; Head ; Humans ; Hydrocephalus* ; Hypertelorism ; Hypertrophy* ; Infant ; Korea ; Magnetic Resonance Imaging ; Male ; Muscle Hypotonia ; Nose ; Palate ; Tetrasomy*

No abstract available.
Carcinoma, Transitional Cell* ; Tuberculosis, Renal* ; Ureter*

PURPOSE: Intractable diarrhea during infancy is one of the major causes of infant mortality. But, its etiology, clinical courses, or methods of treatment are not well known. Therefore, we conducted a clinical approach to intractable diarrhea during infancy. METHODS: We have retrospectively evaluated clinical characteristics, laboratory findings, methods of treatment, days required for recovery, in 23 infants who were admitted with intractable diarrhea, from January 1993 to December 1996. RESULTS: The onset age was 18.4 +/- 17.8 days and the duration of diarrhea was 28.8 +/- 16.5 days. All patients were fed artificial milk before the onset of diarrhea. The possible causes of diarrhea were infection (60.8%), change of milk, milk concentration (17.4%), or an unknown origin (21.8%). Laboratory findings on admission showed hemoglobin 9.5 +/- 2.2g/dL, serum albumin 2.9 +/- 0.7g/dL. E. coli was cultured in urine in 1 case. Stool rotavirus antibody was positive in 1 case. Nineteen patients (82.6%) required total parenteral nutrition for 18.3 +/- 13.6 days and antibiotics were administered to 20 patients (86.9%). Twenty-two patients (95.7%) were fed special element formula milk. All but one who died of necrotizing enterocolitis, recovered. Special element fomula milk was used for 92.6 +/- 20.5 days after discharge, and there were no cases of recurrence. CONCLUSION: We considered appropriate oral element fomulas, total parenteral nutrition and the proper treatment of infection as important factors in future outcome of intractable diarrhea during infancy. We thought the short-term administration of special formula milk can be substituted for normal milk or a weaning diet. However, encouraging breast feeding may perhaps be a more effective way of preventing this problem.
Age of Onset ; Anti-Bacterial Agents ; Breast Feeding ; Diarrhea* ; Diet ; Enterocolitis, Necrotizing ; Humans ; Infant ; Infant Mortality ; Milk ; Parenteral Nutrition, Total ; Recurrence ; Retrospective Studies ; Rotavirus ; Serum Albumin ; Weaning

PURPOSE: Intractable diarrhea during infancy is one of the major causes of infant mortality. But, its etiology, clinical courses, or methods of treatment are not well known. Therefore, we conducted a clinical approach to intractable diarrhea during infancy. METHODS: We have retrospectively evaluated clinical characteristics, laboratory findings, methods of treatment, days required for recovery, in 23 infants who were admitted with intractable diarrhea, from January 1993 to December 1996. RESULTS: The onset age was 18.4 +/- 17.8 days and the duration of diarrhea was 28.8 +/- 16.5 days. All patients were fed artificial milk before the onset of diarrhea. The possible causes of diarrhea were infection (60.8%), change of milk, milk concentration (17.4%), or an unknown origin (21.8%). Laboratory findings on admission showed hemoglobin 9.5 +/- 2.2g/dL, serum albumin 2.9 +/- 0.7g/dL. E. coli was cultured in urine in 1 case. Stool rotavirus antibody was positive in 1 case. Nineteen patients (82.6%) required total parenteral nutrition for 18.3 +/- 13.6 days and antibiotics were administered to 20 patients (86.9%). Twenty-two patients (95.7%) were fed special element formula milk. All but one who died of necrotizing enterocolitis, recovered. Special element fomula milk was used for 92.6 +/- 20.5 days after discharge, and there were no cases of recurrence. CONCLUSION: We considered appropriate oral element fomulas, total parenteral nutrition and the proper treatment of infection as important factors in future outcome of intractable diarrhea during infancy. We thought the short-term administration of special formula milk can be substituted for normal milk or a weaning diet. However, encouraging breast feeding may perhaps be a more effective way of preventing this problem.
Age of Onset ; Anti-Bacterial Agents ; Breast Feeding ; Diarrhea* ; Diet ; Enterocolitis, Necrotizing ; Humans ; Infant ; Infant Mortality ; Milk ; Parenteral Nutrition, Total ; Recurrence ; Retrospective Studies ; Rotavirus ; Serum Albumin ; Weaning

PURPOSE: To evaluate the effect of vitrectomy in IOL power calculation for cataract surgery in the eyes that previously performed vitrectomy. METHODS: This study comprised 41 eyes of 37consecutive patients who underwent cataract surgery after previous vitrectomy. IOL power calculation with the measurement of axial length and corneal power was conducted before vitrectomy and before cataract surgery. Target refractions at each surgery, assuming that the same power of IOL was implanted, were compared to actual manifest refraction after cataract surgery. RESULTS: There was no statistically significant change in both axial length and corneal power after vitrectomy (p>0.05). Before vitrectomy, target refraction was -0.22+/-0.61D compared to -0.37+/-0.52D before cataract surgery. The actual refraction after cataract surgery was -0.47+/-0.94D, and there were no significant differences among the three refractions (p>0.05). CONCLUSIONS: In the eyes that underwent vitrectomy, vitrectomy itself does not have an influence on calculating IOL power for cataract surgery.
Cataract ; Eye ; Humans ; Refractive Errors ; Vitrectomy

The purpose of this study was to analyze and evaluate therapeutic results of stereotactic evacuation of hematoma, urokinase irrigation and external ventricular drainage(EVD) in comatose patients who had hypertensive supratentorial intracerebral hemorrhage. The authors carried out stereotactic evacuation of hematoma and external ventricular drainage in the consecutive 45 cases who were admitted to the Department of Neurosurgery, Chosun University Hospital. from Sep. 1990 to Jun. 1993. The therapeutic results were as follows : 1) The peak age incidences were 6th to 7th decades. The incidence was higher in female than male. The age was not related to the prognosis. 2) The hematoma was located at the basal ganglia in 37 cases, and the thalamic area in 8 cases. The prognosis was poorer as the area of hematoma extended more wider and deeper. 3) The volume of hematoma ranged from 8 to 155 ml. The prognosis of the patient was unfavorable in large volume of hematoma. 4) Intraventricular hemorrhage(IVH) occured in forty cases(89.9%) and mortality rate was 45%. The mortality rate was increased in cases with IVH than in case without it. 5) The mortality rates based on the Glasgow coma scale(GCS) on admission were 50% in GCS score 4 group, 50% in GCS score 5 group, 40% in GCS score 6 group, 27% in GCS score 7 group. Cases of low Glasgow coma scale on admission showed high mortality rate. 6) The overall mortality rate was 42%. These results suggest that stereotactic evacuation of hematoma and EVD decreased the mortality rate when compared with conservative treatment and conventional craniotomy in the literatures.
Basal Ganglia ; Cerebral Hemorrhage* ; Coma* ; Craniotomy ; Drainage* ; Female ; Glasgow Coma Scale ; Hematoma* ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive ; Male ; Mortality ; Neurosurgery ; Prognosis ; Urokinase-Type Plasminogen Activator