No abstract available.
Addison Disease*

No abstract available.
Gynecology* ; Laparoscopy*

PURPOSE: To demonstrate the effectiveness of the conservative treatment which was introduced to the extraarticular triplane fractures of the distal tibia. MATERIALS AND METHODS: We reviewed radiographs and medical records of eight patients with extraarticular triplane fractures of the tibia. Four patients were treated with closed reduction and internal fixation and the others with closed reduction and plaster. RESULTS: In all patients, the union of fractures was obtained. Although the physes were closed early, there was no angular deformity or leg length discrepancy. CONCLUSION: In case of extraarticular triplane fracture, except for open fracture or failure of closed reduction, conservative treatment yield good result.
Child* ; Congenital Abnormalities ; Fractures, Open ; Humans ; Leg ; Medical Records ; Tibia*

Down syndrome is the most common autosomal syndrome in man. The incidence of trisomy 21 due to translocation is about 3.5-5%. Translocations are usually centric fusions between a 21 and a D group (54.2%) or a G group (40.9%) chromosome. Since the short arm of 21 carries no phenotypically active genes, even if the short arm of 21 is lost, usually there is no imbalance with clinical significance. Rare translocations in Down syndrome may also occur between a 21 and other chromosomes (4.9%). We experienced a case of unusual (1q;21q) translocation Down syndrome inherited from a t (1q;21q) balanced carrier mother. The segmental trisomy was confirmed by FISH analysis. This is the first case of a familial Down syndrome with t (1q;21q) in Korea.
Arm ; Down Syndrome* ; Humans ; Incidence ; Korea ; Mothers* ; Trisomy

Although listeria monocytogenes is widely distributed in nature, it rarely causes clinical infection in previously healthy people. However, this microorganism may cause severe infectious disease in pregnant women and newborns due to impaired cell-mediated immunity. Various clinical symptoms have been described such as sepsis, central nervous system infections, endocarditis, gastroenteritis and localized infections. A clinical presentation of listeriosis in an early third trimester pregnant woman and in a preterm infant is emphasized in addition to taking a careful patient history, early empirical administration of antibiotics, aggressive ventilation therapy and also pharmacological support.
Anti-Bacterial Agents ; Central Nervous System Infections ; Communicable Diseases ; Endocarditis ; Female ; Gastroenteritis ; Humans ; Immunity, Cellular ; Infant, Newborn ; Infant, Premature ; Listeria monocytogenes ; Listeriosis* ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnant Women* ; Sepsis ; Ventilation

BACKGROUND: To evaluate the role of emergency debridement performed in conjunction with an empirical antibiotic therapy in clinically diagnosed, full-blown Vibrio vulnificus sepsis. METHODS: Immediate surgical debridement was performed on 13 out of 15 patients who were clinically diagnosed as having Vibrio vulnificus sepsis. RESULTS: Among 15 patients Vibrio vulnificus was isolated in 8 patients. Underlying diseases were liver cirrhosis (2), chronic alcohol ingestion or chronic liver disease (10), diabetes mellitus (3), gastrectomy (1) and in 4 cases no underlying condition was identified. All patients had skin lesions such as erythema, bulla, vesicle and gangrene. All but one initially showed variable degree of hypotension, thrombocytopenia, hepatic dysfunction, renal failure and mental confusion. Their mean APACHE III score was 84. Immediate survival (within 48hrs) in clinically diagnosed Vibrio sepsis was 80% (12/15) and long term survival rate among them was 66.6%. Forty-eight hour survival rate in bacteriologically confirmed cases of Vibrio vulnificus sepsis was 75%, where their long-term survival was 62.5%. CONCLUSION: In treating full-blown Vibrio vulnificus sepsis, immediate emergency surgical debridement performed in conjunction with the empirical antibiotics gives a possibility to improve both immediate and long term prognosis of the disease.
Anti-Bacterial Agents* ; APACHE ; Debridement* ; Diabetes Mellitus ; Eating ; Emergencies* ; Erythema ; Gangrene ; Gastrectomy ; Humans ; Hypotension ; Liver Cirrhosis ; Liver Diseases ; Prognosis ; Renal Insufficiency ; Sepsis* ; Skin ; Survival Rate ; Thrombocytopenia ; Vibrio vulnificus ; Vibrio*

BACKGROUND: Intravenous thrombolysis with alteplase is the most effective therapy for acute ischemic stroke, but hemorrhagic transformation (HT) is a potentially dangerous complication of such thrombolysis. Few studies have investigated the predictors of HT after thrombolysis in Korean stroke patients. METHODS: From 2003 to 2009, acute ischemic stroke patients who received intravenous alteplase were included from the prospective stroke registry of Kyung Hee University Hospital. Patients submitted to CT or MRI scans with gradient echo sequences within 12-36 hours of thrombolysis. The Hemorrhage After Thrombolysis (HAT) score [ranging from 0 (minimum risk) to 5 (maximum risk)] was calculated retrospectively for each patient. The predictive ability of the HAT score for HT and symptomatic intracranial hemorrhage (sICH) was calculated using C statistics. RESULTS: Among 151 consecutive patients, HT was confirmed in 35 on follow-up brain imaging. Atrial fibrillation (OR=2.709, 95%CI=1.118-6.567) and low one-third CT scan (OR=3.419, 95%CI=1.281-9.121) increased the risk of HT after intravenous thrombolysis in multivariate logistic regression analysis. HT, sICH (based on the National Institute of Neurological Disorders and Stroke and the Safe Implementation of Treatment in Stroke-Monitoring Study definitions), unfavorable [modified Rankin Scale (mRS) score of 2-6] and poor (mRS score of 3-6) outcomes at 3 months, and mortality at 3 months were increased with higher HAT scores (C statistic=0.632, 0.637, 0.843, 0.670, 0.689, and 0.659, respectively; p=0.018, 0.036, 0.042, 0.002, 0.015, and <0.001). CONCLUSIONS: The HAT score can be used to predict the risk of sICH following intravenous thrombolysis and the long-term clinical outcome.
Atrial Fibrillation ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Logistic Models ; Magnetic Resonance Imaging ; National Institute of Neurological Disorders and Stroke ; Neuroimaging ; Prospective Studies ; Retrospective Studies ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator

BACKGROUND: Several lymphocytic populations, such as natural killer(NK) cells and lymphokine-activated killer (LAK) cells, are involved in immunosurveillance against tumors. Whereas the biological significance of the regional lymph node as a tumor barrier remains unclear, the clinical prognostic relevance of the neoplastic infiltration of these nodes is accepted. It appears that lymph node metastasis are more frequent in lung cancer than in other cancers because of impaired defensive mechanisms in the regional lymph nodes. However little is known about the immunologic function of regional lymph node lymphocytes in patients with lung cancer. Although there is general agreement that the NK and LAK activities of peripheral blood mononuclear cells(PBMC) decreases in patients with various solid and leukemic tumors, this decrease remains unclear with regard to the NK and LAK activities of their regional lymph node mononuclear cells(LNMC). We performed this study to determine the NK and LAK acti vities of regional lymph node, and to compare with those of peripheral blood in patients with lung cancer. METHODS: We measured the NK and LAK activities of PBMC and LNMC that were extirpated at lung cancer operations in 17 patients with lung cancer by 4 hour 51Cr-release assay using K562, Raji cell and allogenous lung cancer cell line(NCIH1092) as a target cell. E:T ratio were 12.5:1, 25:1, and 50:1. RESULTS: 1. Recombinant interleukin-2 induced strong cytotoxic activities against various target cells in PBMC and LNMC. 2. In patients with lung cancer, NK and LAK activities against K562 and allogenous lung cancer cell line(NCIH 1092) were lower than those of PBMC. 3. Against Raji cell, NK activities were not signifi cantly different between PBMC and LNMC, but LAK activities were significantly lower than those of PBMC. 4. NK activities against K562, Raji, and NCIH1092 cell were not significantly different between in patients with early stage and advanced stage lung cancer. 5. LAK activities of PBMC and LNMC against K562, Raji, and NCIH1092 cell were significantly lower in pa tients with advanced stage than those in patients with early stage lung cancer. CONCLUSION: NK and LAK activities of LNMC in patients with lung cancer were lower than those of PBMC, but the cytotoxicity was markedly increased after culture with rIL-2.
Humans ; Interleukin-2 ; Killer Cells, Natural ; Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Lymphocytes ; Monitoring, Immunologic ; Neoplasm Metastasis

Several suspected etiologies can cause seizures during the resection of a brain tumor via a craniotomy: the tumor itself, intracranial hypertension or the anesthetic agents used, etc. Generalized myoclonic seizures, during general anesthesia in a 44 year old man, who underwent a resection for a relapsed frontal meningioma, were experienced. Anesthesia was induced and maintained using propofol and remifentanil. The myoclonic seizures began 30 minutes after the induction of anesthesia. The administration of rocuronium was unable to stop the involuntary movement. Midazolam was given to cease the seizures, but they continued for a further 105 minutes. After opening the dura mater, the seizures immediately disappeared and did not recur thereafter.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Brain Neoplasms* ; Brain* ; Craniotomy ; Dura Mater ; Dyskinesias ; Frontal Lobe* ; Humans ; Intracranial Hypertension ; Intraoperative Period ; Meningioma* ; Midazolam ; Propofol ; Seizures*

BACKGROUND: Neuronal death in acute-phase cerebral ischemic injury is caused by necrosis. However, neuronal injury after reperfusion can be associated with apoptosis. METHODS: We used Sprague-Dawley rats whose brains were reperfused after middle cerebral artery occlusion for either 30 min or 2 h. We examined a relationship between apoptosis and the expression of inducible nitric oxide synthase (iNOS) in the brain tissue from 3 h to 14 days after reperfusion in both groups. RESULTS: TUNEL and iNOS positivity were closely related in both groups. The 2-h ischemia group exhibited increases in the amount of TUNEL and iNOS-positive cells for up to 3 days after reperfusion, at which the TUNEL and iNOS-positive cells decreased. The 30-min ischemia group exhibited peak positivity 24 h after reperfusion, followed by a similar decrease. iNOS mRNA expression peaked 3 h after reperfusion in the 30-min ischemia group, at which time it decreased. In the 2-h ischemia group, iNOS mRNA increased 3 h after reperfusion, peaked 24 h after reperfusion, and then decreased. CONCLUSION: These results indicated the occurrence of delayed apoptosis in transient cerebral ischemia. Increased expression of iNOS is closely associated with this apoptosis, and oxygen free radical-producing materials, such as nitric oxide, may play an important role in the induction of this apoptosis.
Apoptosis* ; Brain ; Brain Ischemia* ; In Situ Nick-End Labeling ; Infarction, Middle Cerebral Artery ; Ischemia ; Ischemic Attack, Transient ; Necrosis ; Neurons* ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Oxygen ; Rats, Sprague-Dawley ; Reperfusion ; RNA, Messenger